This is my weekly column for the Sunday, Oct. 12 Hibbing Daily Tribune. I archive my columns at my writing site.
Big picture ignored in nursing home issue
By Aaron J. BrownLike many of you, I learned about the impending closure of Hibbing’s Golden Crest nursing home on the front page of the Hibbing Daily Tribune. My first thought was selfish. One of my relatives works there and I was worried for her. But then I got to thinking, a lot of people’s relatives work there. Most importantly, a lot of people’s relatives live there. My grandmother recently went through some rehabilitation there and, when you get down to it, a lot of people’s grandmas and grandpas spend an important part of their lives there.
But zoom out even farther and you see a big picture that means even more than the sad image of this one failing nursing home in this one Iron Range town.
Here’s the short version of the big problem. Nursing homes are heavily regulated and less profitable in comparison with lower cost assisted living facilities and other senior residential options. However, assisted living facilities aren’t equipped to handle high needs patients, are not monitored as closely and cannot provide 24 hour nursing services. State reimbursement rates for high needs, low income people do not cover real costs so there is no financial benefit in serving these folks. The move toward privatized “profitable” care incentivizes serving patients with a lucrative return and creates a whole class of very expensive patients with nowhere else to go.
This week I spoke with three members of the nursing care staff at Golden Crest with more than 60 years of experience among them. In the interests of full disclosure, one of them was my aunt, Colleen Clusiau, the relative I mentioned earlier. After I heard the news about Golden Crest, I asked Colleen to help set up a meeting with her co-workers, nursing assistants and Steelworkers Local 9349 stewards Sherri Senogles and LaVonne Godin.
“This is ripping families apart,” said Godin, describing the turmoil among residents and their families as they scramble to find a new home and proper care.
“The community should be aware of how hard this is on families and residents,” said Senogles.
Discussion of the Golden Crest story has thus far focused on the things easiest to talk about in these modern times: efficiency, infrastructure and numbers. We’re told the Golden Crest building is too old and expensive to bring up to code. It’s all just too bad, we’re told, for the residents and the workers who serve them every day.
“The residents become our families and to lose all of them from our lives at the same time is very traumatic for us and them,” said Senogles. “Will (the next caregivers) know that he likes his juice at 10, that he likes to have the Twins games on at night?”
In the more unregulated facilities where some residents may go, the caregivers will be fewer and less trained and thus much less likely to know these things. But at least those folks will have a place to go. The families of people with significant care needs will be scrambling to find a home for their loved ones. In some cases they may have to leave the community entirely, putting added stress on families.
As stated by officials, Golden Crest’s demise is not the fault of the care workers, nor the fault of the residents, their families or of our community. Nevertheless, these are the people who will pay the price. The problem is not local; it is universal and we must demand a larger solution as the Nov. 29 closure of Golden Crest approaches. In the short term, legislation to allow more beds to be available to affected residents at appropriate facilities might be needed. But that is Step One of several.
I don’t know if this is a modern phenomenon or just an old one that has returned from hibernation. It seems that in all the machinations of corporations, government and the media, we often forget that every headline and sound bite affects people. Every efficiency measure and streamlining puts lives in upheaval. Doing the right thing is often unprofitable. It may be true that the owners of Golden Crest had few options in this matter; we’ll see. But that doesn’t excuse everyone on the Iron Range from dealing with the serious problem of caring for those most in need. Regulatory reform and proper funding are boring and potentially unpopular, but the stakes include no less than our core values as human beings.
Aaron J. Brown is a columnist for the Hibbing Daily Tribune. Contact him or read more at his blog, MinnesotaBrown.com. His new book “Overburden: Modern Life on the Iron Range” is out now. Join him for the grand opening event this Thursday, Oct. 16 from 5-7 p.m. at Howard Street Booksellers in Hibbing.
Thanks for this post (and column). You raise a serious issue about the personal and community costs of nursing home closures. It has become more and more clear to me as I visit and talk to long-term care providers in the state that these centers are more than the just care facilities but also essential employers and important pillars of communities. Trying to balance all of those competing interests (some health care; some not) in an era of really tight human services budgets is a very hard challenge. It has left nursing homes in a terrible cycle of coming to the legislature every 2 years (or every year), hat in hand, begging for money. It is a system that does not work.
You make a good point about regulatory reform, although my impression is that will only take things so far and will not reform the system enough to help things in the long-run. We should do something on regulations (most of which are federal in any event) but we need to be more creative.
We can also add funding (and we have in recent years but not enough particularly to catch up for flat years in the early part of the decade). But we are facing a $2 billion-plus deficit and much of that is likely to be borne by the Health and Human Services Budget. Please remind you readers that when they hear “health and human services” they should be hearing older Minnesotans and people with disabilities because those groups are where a majority of the money is spent.
That said, there are some ideas to change the discussion.
1. We passed a pilot project last year which I hope we can expand called community consortiums. It basically takes money that nursing homes, community-and home-based care providers, transportation providers, etc. now receive in separate streams and put it together in a lump sum. The community (local gov’t, local providers, local non-profits) then has the flexibility to decide how to best spend the money in their community in the way that best serves the long-term care needs of the residents. It is not the state backing away from funding, but instead empowering local communities. The truth is that nursing homes as they exist in Greater Minnesota serve different purposes than in the Twin Cities. One size policy does not serve all. We are also exploring incentives for “Communities for a Lifetime” to move in the same local planning, local control direction.
2. We can be more creative in developing long-term care financing structures. There will be proposals this year to provide tax incentives for people of our age to start saving for long-term care needs so that state funding and reimbursement rates are not the limitation they are today.
There is actually a lot of new thinking going on in this area – unfortunately, perhaps too late for Golden Crest. But we have start acting now to avoid this repeating in the future.
More info: http://paulthissen.com/uncategorized/from-politics-in-minnesota-weekly-report-focus-on-age-wave/
Rep. Paul Thissen
Thanks for the comment, Paul — I’m glad to know you’re working on this. I’ll tuck away your ideas for the next time I write about this,
AB