Awaiting closure and poor care at Ipswich nursing home, latest results from staff crisis

A nursing home crisis in Ipswich, SD, illustrates the two worst potential outcomes of staffing shortages affecting long-term care facilities across the state: possible nursing home closures and troubling incidents of inadequate care to residents.

A staff shortage has been cited as one of the reasons officials at Avantara Ipswich nursing home have said they will close the 40-bed nursing home on May 31, 2022. Challenges relating to COVID-19 have also been listed.

The closure would leave residents and families seeking new care options potentially 25 miles away or more. Employees would also face job uncertainty and the Edmunds County community of 1,000 people about 27 miles west of Aberdeen would see a loss of economic activity. Local civic leaders called a public meeting on April 18 to discuss ways to keep the Ipswich house open.

Staffing issues were also identified by the South Dakota Department of Health, which sent inspectors to the Avantara Ipswich nursing home in April 2021. The state compiled a list of 13 code violations during that inspection. which required 104 pages to document. Four violations were listed as “deficiencies in quality of life and care”.

According to state and federal health department records, which were reviewed by News Watch, the April 2021 inspection found a short-staffed facility with inexperienced and ineffective management and oversight. , and many errors or omissions regarding the way the residents were holding on to.

“The provider failed to ensure that the facility was operated and administered in a manner that provided for the safety and general well-being of the 28 residents of the facility,” the state report concluded.

Legacy Health Care, the Illinois company that operates Avantara Ipswich and 12 other nursing homes in South Dakota, did not return a call or email seeking comment on this story, and the Avantara Ipswich manager told News Watch he was unable to comment. A state health department licensing official also declined a News Watch interview request.

The 2021 inspection report gave examples of serious shortcomings in resident care at Avantara Ipswich. Some residents have lost large amounts of weight; others were found by family members frequently drenched in urine; some had wounds or ulcers that were not documented or treated; and an elderly man had catheter problems that caused his penis to erode.

The impending home closure in Ipswich is an ominous sign for the state’s nursing home industry, which is a critical part of South Dakota’s healthcare continuum and a basic necessity for many residents. the oldest and most vulnerable in the state, said Mark Deak, director of the South Dakota Health Care Association.

Beyond staffing issues, ensuring consistent and adequate funding for nursing homes remains a related and ongoing issue. For every resident on Medicaid, the federal health plan for low-income residents, nursing homes lose more than $50 a day, according to state and federal records. This equation means South Dakota’s roughly 100 nursing homes lose about $56 million a year combined in unreimbursed care provided to Medicaid recipients, who make up about 55% of all nursing home residents. .

The South Dakota Legislature, recognizing the funding crisis, allocated in the 2022 session about $30 million in one-time funding to temporarily boost nursing home results. The funding, which will reach nursing homes by June 30, 2022, is equivalent to an increase of about 20% in annual state funding for nursing homes, according to a legislative budget memo.

Despite the one-time increase in state funding and incremental increases in Medicaid funding in recent years, South Dakota remains near the bottom of all states in Medicaid reimbursement levels.

South Dakota has seen a handful of retirement home closings, mostly in rural areas, over the past five years.

Every time a house closes, it upsets the lives of many people, said Erica Larson, a member of Ipswich City Council.

“It will definitely hurt our little town, for those employees and those families who have loved ones at our facility,” Larson said.

Deak said the combination of an insufficient workforce, rising business and personnel costs, and stagnant or barely rising revenues could have a serious impact on the long-term care sector in the world. South Dakota.

“What’s happening, and it’s a very difficult situation, is that they’re not accepting new admissions; they just don’t have the staff to accommodate new residents who need their care,” Deak said. “And without hiring enough residents, that obviously hurts the viability of their operation, so it really catches them that way and makes it very difficult.”

A survey of nursing homes in South Dakota in 2021 showed that the average salary for a CNA was $14 per hour, or $29,000 per year. Many fast food workers are hired for higher pay in today’s job market, and they don’t have to manage elderly residents, provide them with food, bath and room assistance. swimwear, nor to follow the in-depth training required of CNAs.

To become certified, CNAs must be at least 16 years old and complete 75 hours of classroom and clinical instruction. They must then pass a written or oral final exam and complete a competency assessment that includes performing at least five nursing tasks on a living person.

CNAs must be proficient in medically sensitive areas of competency, including: infection control; monitor range of motion and use of prosthetics or orthotics; use ski lifts; care for patients who lack bladder or bowel control; and the management of patients with dementia or cognitive decline.

The Evangelical Lutheran Good Samaritan Society, which operates 23 housing campuses in South Dakota, many with nursing homes, is taking aggressive steps to recruit and retain more healthcare workers, said Rochelle Rindels, vice- president of the agency’s nursing and clinical services.

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As of mid-April, Good Sam had about 1,000 nursing employees, but about 250 open positions in South Dakota, including 65 openings for registered nurse positions and about 180 CNA openings.

Working as a CNA is hard work that requires a great level of focus and commitment, Rindels said.

“If someone comes to the job and doesn’t really expect what the job would be or look like, it can lead to burnout.”

Good Sam is working to become more competitive on compensation, especially for CNA positions, recently investing $15 million to raise salaries for healthcare workers. Last year, the agency developed a new program to recruit and pay to train people interested in the CNA position, Rindels said. So far, about 600 students have entered the program and more than 90% have passed and passed the state certification exams.

Rindels said additional training programs, new sources of funding and expanded employee support systems are needed at the federal and state levels to stabilize staffing at South Dakota nursing homes.

Deak suggested that perhaps immigrants from Ukraine, fleeing war in their country, could help fill employment gaps in South Dakota nursing homes.

State follow-up reports indicate that the deficiencies found during the April 2021 inspection have been corrected.

Connie Ortega, head of Legacy Health Care, said residents and their families will receive individual plans to relocate and continue their care, according to the release.

Other Avantara nursing homes operated by Legacy Health Care in South Dakota are located in Arlington, Armour, Clark, Groton, Huron, Lake Norden, Milbank, Pierre, Rapid City, Salem and Watertown.

— This article was produced by South Dakota News Watch, a nonprofit journalism organization located online at SDNewsWatch.org.