Long term care beds decline across Wisconsin as 600 hospital patients wait for their own

STOUGHTON, Wis. — At one Stoughton nursing home, a small recent coronavirus outbreak in October pointed to staffing concerns for CEO Kris Krentz, his staffing down since the pandemic began.

“I come to work every day knowing what a couple of positive tests could mean: we go into lockdown again with our visitation; residents could be positive, staff could be positive, I could lose the next percentage of the workforce. How am I gonna get that covered?”

Throughout Wisconsin, hospitals are facing a crisis as COVID fills their patient beds and Omicron prepares to sweep the state.  Part of the problem: hundreds of patients who no longer need hospitalized care, but have nowhere to go as they wait for long term care beds to open.

The number of long term care beds in Wisconsin has fallen by about 1,600 during the pandemic–the equivalent, LeadingAge Wisconsin CEO John Sauer said, of about 23 facilities. Just over half of those beds closed between March and the end of December in 2020, with 667 beds closing in 2021.

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Data on long term care beds across Wisconsin, graphic provided by LeadingAge Wisconsin

It’s not that the beds are often physically removed: they’re decommissioned with the state, because facilities don’t have the staff to support them.

“We cannot jeopardize the services that those individuals need,” Sauer said. “Even though hospitals are backed up and in a critical situation, we’re not able to admit many of those patients because we cannot admit people for whom we have no staff.”

According to the Wisconsin Hospital Association, about 600 hospital beds currently are being used by patients across Wisconsin who no longer need hospitalized care but are waiting for beds to open in long term care facilities.

After COVID, many patients need step-down care for months in those types of facilities. Other times, Krentz said, it’s patients recovering from surgery or other types of lengthy hospital stays that need short rehab stays in skilled nursing before returning home.

Yet as the trend continues, begun before the pandemic but exasperated by it, it’s contributing to a hospital crisis that threatens to be overwhelmed by Omicron. State and federal law prevent facilities from taking on more residents than they’re staffed to manage, Sauer said, so in the meantime–beds stay empty, in darkened rooms, as staff dwindles.

“We’re not admitting at the pace that the current pandemic urges us to do.”

At Skaalan, admissions continue, as they’re able. Referrals are coming from farther and farther away, Krentz said, as hospitals expand the circles where they normally call to send patients. But they’re down by 15 to 20% from their pre-pandemic workforce, and as a result, they can’t operate at capacity.

“It was a preexisting problem, and I think the pandemic has only exacerbated it,” Krentz said. “There’s not one silver bullet that’s gonna fix this; it’s gonna be a bunch of little things.”

The faith-based nonprofit recently had their union ratify a new contract, providing starting pay increases for the first time in three years, a change Krentz welcomed. But for the most part, raising wages is a nonstarter.

“The Medicaid system in Wisconsin has been broke for a long time in terms of reimbursement,” Krentz said. “We don’t get our costs covered, so we can’t afford to pay our workers as much as the Kwik Trips and Walmarts of the world either.”

Processes kickstarted both before and during the pandemic are in place at a state level to help address the shortage. The most recent state budget includes extra funding in the Family Care program to help facilities recruit and retain staff; additionally, the Department of Health Services has been offering supplemental staffing to facilities since October.

Additionally, some federal COVID relief funds are being used to alleviate the crisis in the form of provider payments, among other longer-term measures from the Evers Administration.

Nationwide, pay for long term care workers is inching up–a trend Sauer hopes to see continue in Wisconsin, with the ongoing help of incentives and alternatives like tuition reimbursements and scholarships for students. But in the immediate, LeadingAge Wisconsin is asking the state for temporary workers through either FEMA or the National Guard–anything to help alleviate the crisis. Additionally, in a letter to the DHS deputy secretary dated December 17, Sauer pointed to the wage crisis as a factor.

“The underfunding of elder care is a long-standing systemic problem in our nation,” he wrote. “Wisconsin is making great strides, but these strides may be too little too late if we don’t double down on the commitment to frail elders in Wisconsin and protect the access we have.”

Leaders say vaccine mandates–required by the federal government in Wisconsin for regulated homes (the order faces a court-ordered temporary stay in ten other states)–may have contributed to a small number of departures, but not the main crisis. Statewide, Sauer estimates 5-8% of departures may have been impacted by mandates. At Skaalan, Krentz said more than 95% were compliant with a mandate and several others qualified for religious or medical exemptions.

Mostly, it’s attributed to pandemic fatigue and industry trends, Krentz noted.

“There’s a lot of jobs out there that pay more without as much stress.”

Photojournalist Lance Heidt contributed to this report.