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Just how bad is the staffing problem at Minnesota’s long-term care facilities and hospitals?

Among other things: a new survey of long-term care providers found roughly 76 percent are limiting admission to their facilities. 

COVID-19 patient
REUTERS/Nick Oxford

As COVID-19 cases continue to surge in Minnesota, hospitals and long-term care facilities are dealing with prolonged staffing shortages, resulting in less care for patients and financial problems for medical systems.

Gov. Tim Walz has taken some steps to alleviate the issues, like activating National Guard members to help at long-term care facilities, calling in federal medical teams for hospitals, and approving $50 million for things like hiring and retention bonuses in the health care sector.

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Health officials and legislators are also debating other potential steps. The Minnesota Senate GOP has proposed a new $150 million plan for nursing home relief, and hospital representatives have argued for short-term help with things like background check requirements while also advocating for longer-term assistance such as loan relief for workers.

On Wednesday, state Sen. Jim Abeler, R-Anoka, convened the Senate’s Human Services Reform Finance and Policy Committee to hear from long-term care facilities and hospitals about how they’re dealing with staff problems and to ask more about the impact of current vaccine mandates and a potential requirement from the federal government.

Here’s what we learned:

Long-term care staff shortages are ‘huge’ and limiting admissions

The number of open jobs in long-term care continues to grow in Minnesota, said Nicole Mattson, vice president of strategic initiatives for Care Providers of Minnesota, a long-term care trade group.

State Sen. Jim Abeler
State Sen. Jim Abeler
A fall survey done by her group and the similar LeadingAge Minnesota found an average of more than 2,000 more “staff exits” than hires each month and about 15,000 openings for direct caregivers. “Providers inability to attract new staff in, and the burnout and exhaustion experienced by current staff which accelerates turnover, have hampered any efforts to return to normal operations,” Mattson said at the hearing Wednesday.

A new survey of long-term care providers found more than 76 percent are limiting admission to their facilities, up from 70 percent in the earlier fall survey, Mattson said. In rural parts of the state, the problem is even worse. Mattson said more than 90 percent of providers there are limiting admissions. 

“This is extremely unusual,” Mattson said in an interview Wednesday. “70 percent is a huge number … What’s typical? I mean less than 10 percent at any given time would be limiting admissions. We’ve had workforce issues in the past but nothing, nothing has ever compared to this.”

Cami Peterson-DeVries, a adult-geriatric nurse practitioner for St. Francis Health Services of Morris, which operates mostly in rural areas and has 13 nursing homes, 10 assisted living facilities and more than 70 group homes, told the Senate committee that some of their care centers are at 60 to 70 percent occupancy. And despite efforts to recruit and retain workers — made more difficult by nearby high-paying Mayo Clinic facilities — they’re paying out huge amounts in bonuses and overtime to cover shifts.

Mike Deuth, regional executive director for the Good Samaritan Society for Minnesota, Wisconsin and Ohio, said the group has 28 nursing homes, 31 assisted living facilities and a variety of home health and hospice homes in Minnesota. The organization has resorted to hiring outside agencies to bring in staff, something it budgeted $690,000 for in Minnesota but has ended up spending $6.73 million on so far in 2021.

“For the month of November, we spent just shy of $1.5 million,” Deuth said. “It’s simply not sustainable.”

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Diane Rydrych, assistant acting commissioner for the Minnesota Department of Health’s Health Systems Bureau noted staff shortages have been a problem before the pandemic, but said there are new challenges. Typically about five nursing homes close in any given year, and Rydrych said at least four have closed or will close by the end of the year, not specifically for pandemic-driven staffing issues. But she said “I do think that there are some that are at risk” of closure, despite state efforts to help with staffing shortages.

What a staffing shortage means for hospitals

The long-term care industry is not the only one facing workforce shortages. Mary Krinkie, vice president of government relations for the Minnesota Hospital Association, said at the start of the pandemic, when hospitals talked about capacity, they had beds and space, staffing and equipment in mind.

“It was all about the number of ventilators we had, and all about our personal protective equipment and could we get enough PPE for our employees,” she told the Senate panel. “As we fast forward now 20 months later it’s all about staffing, or more particularly the lack of staffing.”

Mary Krinkie
Mary Krinkie
Krinkie said hospitals this past week were caring for roughly 7,223 inpatients, which was maximum capacity for the system. But in July of 2020 that number was as high as 8,355. For the last three months the state has had very little intensive care bed capacity, she said. “This is not because there’s a reduction in demand,” Krinkie said. “It is because there just is not enough health care staff to care for the patients who want care or need care.”

Krinkie said one major hospital system in the state told her their overall job applications had fallen by 50 percent compared to a year ago. And “critical access hospitals” in rural areas said on average they have job vacancy rates of over 11 percent.

As a result, hospitals have canceled all procedures “except for basically those that are life saving” or would prevent “extreme harm” to a patient, and are dealing with skyrocketing costs to hiring nurses through outside agencies or “temporary float pools.” 

“Hospitals are under enormous financial pressure, canceling surgeries and increased volumes of Medicare and Medicaid patients and we’re paying a lot more for staff,” Krinkie said.

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Vaccine mandates are only a small portion of staffing issues

Abeler probed the health officials about vaccine mandates — including those created by a private employer or the one President Joe Biden’s administration has proposed but is on hold in the courts — and asked some whether they have hurt staffing levels significantly. The answer from those testifying was largely no.

Dr. James Watson
Dr. James Watson
Dr. James Watson, a Mayo Clinic neurologist, said no staff have been fired for not complying with their vaccine requirement, though their deadline for vaccination is Jan. 3. He also said the majority of requests for exemptions based on religious beliefs or medical reasons have been granted.

Allina Health has fired 53 employees out of more than 27,000 workers and has a 99.8 percent compliance rate with its vaccine mandate — including medical and religious exemptions, said Kristen McHenry, director of government relations for the medical system.

When it comes to nursing homes and long-term care facilities, the answer was somewhat more complicated. Rydrych said the vaccine mandate “is one factor that I think has made things more challenging for some facilities in areas of the state, especially where vaccine rates for health care workers are low.”

The injunction pausing the mandate “may have given some facilities a little bit of time to take a breath and plan for what’s going to happen if it does get reinstated,” Rydrych said. “But it is a serious issue, mandate or no.”

Peterson-DeVries, from St. Francis Health Services, said she didn’t have exact numbers of how many people have left in anticipation of vaccine mandates, but said some people did. There are also some places where employees are waiting to make a last-minute vaccine decision, she said. And Peterson-DeVries predicted a mandate would lead to fewer workers, particularly in northern Minnesota.

Deuth said the Good Samaritan Society is a division of Sanford Health, which has a vaccine mandate. Of Sanford’s 48,000 workers, more than 300 people have not been vaccinated or received an exemption, he said.

Abeler asked repeatedly for health care systems to not quickly dismiss people seeking vaccine exemptions, particularly for religious reasons, even if he said the employers had a right to seek the mandates. He also said describing vaccines as safe and effective “is a little simplistic” in part because of self-reported adverse reactions in a government database. More than 3.67 million Minnesotans have received at least one dose of a COVID-19 vaccine. State and federal health officials say the vaccines are incredibly safe and the benefit of strong protection against severe coronavirus cases far outweighs the small risks of complications from vaccination.

Describing Mayo’s rationale for a vaccine mandate, Watson said: “Our highest obligation is to do everything in our power to keep our patients safe. We’re a destination practice. We care for those patients who are acutely ill with complex medical needs. Those patients have the highest risk from COVID.”

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What we know about national guard deployment

Gov. Tim Walz announced Monday that three National Guard teams were deployed to long-term care facilities in New Hope, Onamia and Fergus Falls to help with severe staffing shortages. 

Gov. Tim Walz
REUTERS/Brian Snyder
Gov. Tim Walz
Rydrych, from MDH, said about 400 soldiers have completed nursing training and at least nine teams are expected to be deployed by the end of the week. The state got 42 requests so far for help from long-term care facilities.

There are some limitations for the teams. They won’t be sent to areas with active COVID-19 outbreaks, and Rydrych said each team will help a facility for two weeks at a minimum but only three weeks at a maximum. After that, Rydrych said the state will help facilities determine what other help they may be eligible for and talk them through what additional steps they’ll take to fix their shortages.

“I think for some of them this creates a softer landing,” Rydrych said. “They may be pretty far down a path and they may be already considering closure.”