How a state board is trying to fix crisis in nursing home staffing

NINA MOINI: Minnesota is working to stabilize its nursing home workforce, which has long struggled with high turnover, especially in rural communities. MinnPost state government reporter Matthew Blake published a series looking into the state's plan to revitalize the nursing home industry. That includes looking at the retainment of employees, the complicated financial situations of nursing homes, and labor standards. Matthew joins us now to share more about his reporting. Thanks for being here, Matthew.

MATTHEW BLAKE: Yeah, thanks so much for having me.

NINA MOINI: What got you interested in looking into nursing homes?

MATTHEW BLAKE: Yeah, so I started as a state government reporter for MinnPost in March, when the legislature was in the thick of being in session. And I went to this House floor hearing, and this argument spilled out over this thing that I had never heard of called the Nursing Home Workforce Standards Board. And House Republicans, Representative Natalie Zeleznikar, were saying that the board was going to bankrupt nursing homes and that rural Minnesotans would no longer have access to nursing homes, and House Democrats were saying that the board is finally giving workers a voice in the nursing home industry.

And so I pursued learning about this Nursing Home Workforce Board because I thought maybe by learning about nursing homes I could better understand how Medicaid works in Minnesota, but also understand the values of the state in terms of what they prioritize for end-of-life care.

NINA MOINI: Yeah. And so in your reporting, did you identify maybe a few of the biggest issues that are facing the nursing home industry in the state?

MATTHEW BLAKE: Yeah, for sure. So a lot of the reporting-- because I'm focusing on this thing called the Nursing Home Workforce Standards Board, which just started a year ago-- a lot of it is focused on workers. And so in Minnesota, approximately 36% of nursing home workers leave their job before a year on the job. And what the state government wants to do is develop a minimum wage for these nursing home workers of $19 an hour, a little more if you have a certified nursing certificate, and the state hopes that this minimum wage will lead to higher worker retention.

Now, what I have not been able to find in my reporting so far is whether this is true, because this rule does not go into effect until January. One finding that I did have in my reporting is that frustratingly, maybe, for readers, it is very hard to get good data on nursing home finances. You talk to nursing home operators, you talk to the nursing home lobby, they're crying poverty. They're saying they're losing money. They're saying nursing homes, especially in rural Minnesota, are shutting down. But nursing homes only report their costs to the state and federal government, and so we don't know the revenues that nursing homes are making. And it can be hard to siphon out whether they're really losing money or not.

NINA MOINI: Yeah. So it sounds like there was opposition, as well, to this $19 minimum wage idea to help with retention. Who was opposed and why?

MATTHEW BLAKE: Yeah. So there's pretty fierce opposition. So before this minimum wage rule, the Nursing Home Workforce Board has already implemented this rule mandating time-and-a-half pay for federal holidays. And the nursing home lobby, which includes the group LeadingAge Minnesota, they filed a lawsuit against the Nursing Home Workforce Standards Board. The lawsuit was unsuccessful, but its basic legal contention was, hey, we can't both follow this new state law and follow collective bargaining agreements that we've already hammered out with our nursing home workers-- if we follow the state law, we might be in violation of the National Labor Relations Act. If we follow the National Labor Relations Act, we might be in violation of state law.

And so I think what you're going to find is potential future litigation about these new minimum wage laws. And also, you're just going to find overall opposition from many nursing home operators, and it remains to be seen how many will comply with the new law and how many might not.

NINA MOINI: And Matthew, it was striking-- I think you said 36% of people will leave their job. I guess more than a third, more than one in three. I mean, what's going on there when you're talking to people working in this industry? What is making it so hard to have that staff retention?

MATTHEW BLAKE: Yeah. So I had a lot of very interesting, and somewhat painful, at times, interviews with nursing home workers, and they cited a few factors. One thing is that many nursing home workers begin working at nursing homes when they're in high school, when they're in college. A colleague of mine was telling me how when she was at the University of Minnesota, there would be job postings to get undergraduate students to work in a nursing home. So a lot of people start out young at the job thinking they can earn a little extra money or interest in the nursing profession, and then they realize that the job is way more intense than they bargained for, and so they leave. And so that's part of the turnover.

Another part of the turnover is just the day-to-day intensity of the job. If you're a nursing home worker, you have to manage medications. You have to make sure one medication does not interfere with someone taking a different medication. You have to act as a therapist to many of these people. You have to dress them. You have to bathe them. And also you're just continually dealing with death and you're dealing with people at the end of their lives, and that's a very emotionally intense thing for most people. And so what I would also finally say about that is that there's a vicious cycle where, because turnover is so high, you have situations where nursing home workers are constantly needing to deal with new colleagues, and so that also adds to their stress.

NINA MOINI: And so I'm reading here that Minnesota's nursing home care economy, though, is actually doing better than a lot of other states, even in terms of staff turnover. I feel like I hear that often in Minnesota. There's an issue, doing better than other states, perhaps, but an issue nonetheless here for a lot of people. What are lawmakers concerned about, and are they moving toward passing any other types of laws that may be for more accountability? You were saying about reporting finances and things like that.

MATTHEW BLAKE: Yeah, so a couple of things on that. Yes, as you mentioned, one thing that I found during this job at MinnPost is that Minnesota is seen as a national leader in terms of a lot of health care measurements. The AARP has called Minnesota maybe the best state in the country for elderly care. The state is very good at using its Medicaid money opportunistically. That all said, the state is in a situation where it's facing this really high turnover, and it's also facing this lack of knowledge about whether nursing home finances are in peril or not. And so one thing that the state might do going forward is raise the Medicaid reimbursement rate, raise the rate that nursing homes get for taking care of patients on Medicaid.

Another thing that might happen is greater auditing of nursing homes. I spoke with the Department of Human Services for this story, and the Department of Human Services admitted that there's a lot about nursing home revenue that we're not auditing right now and that we don't know about right now. There's a lot even about nursing home costs that we're not auditing right now. And in their communiques with me, DHS pledged that they would come up with new ways to audit nursing homes. So that's a change that I would expect to see in as soon as the coming weeks and months.

NINA MOINI: All right, Matthew, thank you so much for stopping by Minnesota Now and sharing your reporting with us. Really appreciate your time.

MATTHEW BLAKE: For sure. Thanks so much for having me.

NINA MOINI: That was Matthew Blake, MinnPost state government reporter.