Minnesota's nursing homes say they are caught in a problem of the state's making, and they are asking the state Legislature to help fix it.
The homes say they can't pay staff competitive wages, and that's hurting care for residents. They'd like to be able to pay more, but they can't, because the fees they can charge residents are set by the state.
The result, according to some who work in the field, is a crisis.
"I've been doing nursing home work for a lot of years," said Cami Peterson-DeVries, manager of RenVilla Health Center, a facility about two hours west of the Twin Cities. "This year, it feels like we are in the crisis. We predicted crisis in 2015 was going to occur."
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Cynthia Turrubiartes, a certified nursing assistant at RenVilla, said that staff shortages affect the care patients receive. Residents notice when nurses are slower to get to daily tasks, and Turrubiartes said she notices the little things: "You know, like a smile. ... They can't smile because we haven't brushed their teeth."
Peterson-DeVries expects at least 10 percent of her staff to leave this spring for higher-paying work in the town's sugar beet processing plant. And she thinks others will leave for work in local hog barns.
At RenVilla Health Center, the starting wage for certified nursing assistants is $9.45 an hour. Even low-skill jobs in the area pay more than that.
"I think that our staff are getting upset and angry. They are tired," Peterson-DeVries said. "I would hate to see any of them go out the door, but they can only do so much."
She said high staff turnover can be difficult for residents, who get used to their nurses. And it can be a challenge to keep up a consistent quality of care.
But she knows the staffing problems she's facing are not unique to Renville. Peterson-DeVries and other nursing home operators say the state-imposed limits on what they can charge residents amount to a cap on how much they can pay their workers.
Nursing homes pay nursing assistants about $6 an hour less than hospitals do, according to a recent survey by industry groups.
Legislators have introduced bills that would change the formula the state uses to set nursing home rates.
Rep. Joe Schomacker, R-Luverne, is sponsoring the House bill. He faulted the current system for not adjusting automatically to rising costs.
"What we've seen over the years is the state isn't keeping up with the cost of care," he said. "It should keep up with inflation and recognize the actual cost of taking care of our elderly."
The proposed change would cost the state about $200 million over the first two years.
Peterson-DeVries said she's not sure what will happen if the legislation doesn't pass.
"I think it's really, really scary," she said. If the initiative fails, she said, "facilities aren't going to be able to make it. Facilities are going to close, which we've seen, because of staffing."
She said the nursing home she manages would have to reduce its number of residents. RenVilla is usually full.
Gov. Mark Dayton said Monday that he plans to request more money for nursing homes in his revised budget next week.