Care industry stressed for funds, workers

By LAURA BEHENNA Bigfork Eagle

The Bigfork Eagle continues its series of articles about the pressure of growth on local services and organizations.

Boomers, if you’re not taking care of your health now, you might want to start.

The arrival of the baby boom generation in the ranks of elder Americans will present a huge challenge to an already stressed long-term care industry, Brent Smith, the director of Lake View Care Center in Bigfork, said. Americans born between 1946 and 1964 are nearing the age when they will need more health services, but the current health care system is nowhere near ready for them.

“We’re just starting to see the first phases of that,” Smith said.

The U.S. Census Bureau estimates 28 percent of Bigfork’s 2,250 residents are 65 years old or older, more than double the national averaqge of 12.4 percent. Forty-three percent of the population is at least 45 years old.

“With the aging of the existing population and an influx of retirees, the population of [Bigfork] will require increased services such as medical care, assisted living and public transportation,” the September 2005 edition of the Bigfork Neighborhood Plan states. That prospect worries Smith.

“As the baby boomers age, there’s going to be a humongous influx of people who need health care services, whether it be hospital or nursing home,” Smith said. “How is the current system going to fund that? How are we going to staff for that when we’re having a hard time getting staff now?”

The severe shortage of nurses and nursing assistants is happening mostly because health care facilities can’t afford to pay the wages people want, Smith said. A nursing assistant starts out at $10.25 an hour at Lake View. He’d like to pay them at least two dollars more, but 66 to 70 percent of Lake View residents depend on Medicare and Medicaid, federal programs that often pay the center less than the actual costs of providing care, he said.

Right now, private-pay residents pay an average about $4,500 a month at Lake View, and Medicaid reimburses the center about $4,450 a month for low-income residents, Smith said. The difference adds up.

Meanwhile, as the Flathead Valley grows, competition for good wages increases.

“No one wants to work at a nursing home when they can make just as much at McDonald’s,” Smith said. “It’s hard work.”

“The challenge is finding, keeping and motivating really great caregivers,” the center’s director of nursing, Angie Wilkening, said. She runs job ads regularly and offers hiring bonuses to attract new staff. The center also provides free training for new nursing assistants at Flathead Valley Community College.

“We pay a lot for training,” Smith said.

Every new legislature and presidential administration adds more regulation to Medicare- and Medicaid-certified health care facilities, adding more layers of expense, he said.

Long-term care is “one of the most regulated industries in the country,” he continued. “We have over 600 regulations we have to abide by, so there’s a lot of bureaucracy, a lot of red tape.”

For example, most staff members spend hours filling out forms when he’d like to see them available to provide more hands-on care, he said.

“I’m not saying regulation is bad, necessarily, but I don’t think there’s a lot of thought given to the cost of all these regulations. We may need to more staff to comply. That adds cost, and where does that money come from?”

If the red-tape burden were lighter, Smith would plow the freed-up money into improving patient care, providing more staff and updating residents’ rooms and living environment.

“I would much rather put our energies and our resources into resident care,” he said. “To be able to give a better quality of life to our residents: That’s our main goal.”

Litigation risk slams the long-term care business with even more expenses, Smith said. If someone accidentally falls or a staff member forgets to record when a resident took a medication, a lawsuit could follow.

“Liability is a huge issue,” he said. “We’re starting to see more and more litigation where attorneys are actually reading obituaries and making phone calls to family members. First question they ask is, ‘Was your loved one in a nursing home?’ Then they try to use the legal system to sue the nursing home.”

This dreaded scenario hasn’t happened at Lake View Care Center yet, “but it’s happening in Montana,” Smith said. “They’re becoming more and more aggressive. It’s a tough, tough business to be in.”

Smith proposes several solutions to improve the situation, most of them legislative. First, the law needs to be reformed to prevent the greedy from profiteering at the expense of nursing homes, he said. Next, legislators should allocate more money for wage increases.

“Our legislators need a wake-up call,” he said. “They need to realize we can’t provide quality care unless we have the tools to do that - and the tools to do that are the people trained to provide that hands-on care. With the huge budget surpluses in Montana, they should be anteing up and helping us out.”

It’s difficult to ask taxpayers for more money for elder care, Wilkening said, “but costs keep going up and that’s hard to deal with.”

Medicare and Medicaid should provide reasonable reimbursement too, Smith asserted. For example, Medicaid no longer pays for eyeglasses, dentures or hearing aids, he said.

“Each year the payment system gets racheted down a little more,” he said. “They keep cutting, cutting, cutting.”

Smith would like to see the state’s nursing home inspection system become less “antagonistic,” he said.

“We work really hard to try and comply with the regulations,” he said. “The [inspection] surveys are a good idea because we need to be held accountable, but it seems like the relationship could be more cooperative and less punitive.”

As Lake View Care Center and other health care facilities grapple with these issues, the baby boom generation looms on the horizon. Smith expects boomers to be much more demanding about quality of nursing home care they receive than earlier generations have been.

“We expect the best care, best experts, best tests and all the latest drugs,” Wilkening agreed.

“There’s going to have to be a reallocation of resources to help fund for that,” Smith said. “I think our leaders are really going to have to take a hard look at it. If the money’s not going to be there, the care’s not going to be there. People need to be paid to do the work.”

Still, Smith and Wilkening said they find their jobs satisfying and see hope for the future. The nursing home industry has improved the quality of care it provides in recent years, and Lake View has a dedicated staff and excellent working relationships with local and county health care providers, Smith said. Volunteers and children visit the center to play music and games, sing, make decorations and visit with the residents, Wilkening said. Residents receive free transportation to appointments in Kalispell.

“We think one of our greatest strengths is our close ties to the community,” Wilkening said.

Starting in the late 20th century, both public and private agencies have been improving community-based services that allow seniors to receive care in their homes, allowing them to live independently longer than in the past, Wilkening added. In addition, assisted-living facilities now care for many elders who would have been placed in nursing homes 10 or 15 years ago.

It’s cheaper for someone to pay for [part-time] home care if they don’t need the level of care a nursing home provides,” Smith said.