May 5, 2022

Featured News

11% of Nursing Homes; 20% of Assisted Living Face Closure According to New Long-Term Care Imperative Survey

On May 5, 2022 by Jeff Bostic

Aging services providers across the state face dire financial conditions that jeopardize access to care for Minnesota's seniors, according to a recent survey conducted by the Long-Term Care Imperative.

The survey – which garnered responses from 156 care centers and 179 assisted living settings – illustrates the challenges faced by providers during this unprecedented workforce shortage. The survey findings are sobering and show that providers have been doing all they can to respond to the workforce crisis, creating an existential threat for many of them.

Negative 8.7% Operating Margin for the Average Nursing Home

For care centers, the most significant finding is that March's financial performance was abysmal, with a median operating margin of negative 8.7%. If March is indicative of all of 2022, the average care center will lose almost $900 thousand on operations, which is a considerable problem when many of them have already used some or all of their reserves. The financial performance is primarily driven by significant increases in expenses, including the large number of providers who have given employee wage increases of more than 10% in the last two years and the number experiencing large spikes in temporary staff use and the cost of that staff.

One significant finding is the number of providers looking at sales or closure as they continue to struggle financially. 11% of care centers, which works out to about 40 statewide, indicated they are looking at those options. That will have severe impacts on access if it comes to pass, and the number considering those options is likely to grow if the financial performance from March continues for several more months.

20% of Assisted Living Face Closure

For assisted living settings, the picture is also quite challenging. While financial performance is not as gloomy as care centers, they are at a median operating margin of negative 1% in March. An even higher proportion of them have increased employee wages by more than 10%, and they are using reserves to cover those and other increased costs in many cases. While they are more able than care centers to raise charges to stabilize their financial performance, the ability to do so will be limited by market realities. In many cases, it has been already.

The number of assisted living providers considering closure or sale is even higher than care centers, at around 20% or about 400 locations statewide. If numerous sites close, that will cause substantial access problems for this service, when alternatives like care centers are also under stress and may not be able to take the clients who cannot access assisted living sites.

Action Needed Now to Help Struggling Providers

The story told in the data is staggering, and the Long-Term Care Imperative understands the importance of sharing this story to help advocate for action. To help aid in our advocacy efforts and encourage the legislature to pass funding to support caregivers with the wages they deserve and ensure access to care for Minnesota’s one million seniors.

We cannot address this crisis without your help and a bipartisan commitment to supporting the care our growing senior population needs.

This starts with adjustments to state Medicaid rates for senior care services to support competitive, family-sustaining wages. Minnesota has over 23,000 open positions in nursing homes and assisted living settings. Without sufficient staff, senior care providers cannot admit residents, resulting in revenue losses for organizations throughout the state.

Take Action

In addition to efforts to garner media attention, we will ask all providers to contact the Governor on Monday, May 9, to share why action is needed. Our goal is to flood his office with calls that illustrate just how dire the circumstances of inaction this session are.

On Monday, May 9, we ask you to call Gov. Walz; click here to connect or dial 651-370-8632. Tell the person who answers the phone that seniors and their caregivers need action this session. Here are suggested talking points you can use:

• Hello, my name is ____, and I provide care in a long-term care setting.
• According to a recent survey conducted by the Long-Term Care Imperative, 40 nursing homes and 400 assisted living settings face closure.
• Over 14,000 older adults are in jeopardy of losing the care they need in long-term care settings throughout the state.
• Without permanent investments from the state, the average nursing home is projected to lose over $800k this year alone.
• This crisis will continue to worsen for seniors needing care if left unsolved until the 2023 session. Lawmakers cannot go home without taking action.
• In the final stages of the legislative process, I respectfully ask that seniors and their caregivers be your top priority. Invest in the wages professional caregivers deserve and help ensure access to care for Minnesota’s growing population of seniors!
• Please support the Senate’s Health and Human Services bill that funds permanent wage increases needed to recruit and retain professional caregivers.

Thank you for your advocacy. With only a few weeks left in the legislative session, we’ve got to keep the pressure on to garner support for the funding needed to pay caregivers the wages they deserve and ensure access to care for Minnesota’s seniors.

Long Overdue Frontline Worker Bonuses Signed into Law

On May 5, 2022 by Erin Huppert

On Friday, April 29, the legislature passed a bill to provide frontline workers a bonus check for their commitment to serving our community during the height of the pandemic. The measure will use $500 million of federal funds to provide "hero" payments to an estimated 667,000 frontline workers in specified sectors, including long-term care and home care settings like nursing homes and assisted living.

What We Know So Far

For caregivers: Frontline workers will need to attest that they meet specific eligibility criteria to receive $750 to $1500 (the bonus amount will depend on the number of applicants). Eligibility criteria for a bonus include terms of employment (work at least 120 hours from March 15, 2020 – June 30, 2021), inability to telework, whether you received unemployment insurance benefits, and income (less than $350,000 for joint tax filers, and $175,000 for single tax filers if you had direct COVID patient care, and less than $185,000 for joint tax filers or $85,000 for all other tax filers for non-patient-facing roles). The Department of Labor (DLI) will be creating an online portal where caregivers will be able to apply for the bonus. DLI estimates it will take a few months to get the portal up and running, but importantly, applicants will only have 45 days to apply once the site is live.

For employers: DLI will create a notice for employers to "conspicuously display" to notify employees of their potential eligibility for the frontline worker payment. Additionally, the notification must be provided to all employees in a paper or electronic format as soon as it is available, given the 45-day application limit. Unfortunately, this law will not reimburse employers who provided a voluntary bonus to employees during the peacetime emergency.

DLI is in the process of opening a multilingual call center to help answer questions. Additionally, Caregivers and Employers can sign up at frontlinepay.mn.gov to receive state updates about Frontline Worker Pay, and LeadingAge will continue to share information with members as it becomes available.

State News

Nursing Assistant Test Sites Weekly Update

On May 5, 2022 by Anna Mowry

With the 1135 waiver ending on June 6, members will have until Oct. 6 to place Nursing Assistants on the state registry. Minnesota State and the Minnesota Department of Health (MDH) communicate weekly updates to LeadingAge Minnesota regarding nursing assistant test sites as they open and increase their capacity.

To see available nurse assistant testing, go to:

• Nursing Assistant Knowledge Test
• Nursing Assistant Skills Test

This Week’s Testing Site Updates:

• Openings: Anoka Technical College, St. Cloud State University, South Central College, Minneapolis Community and Technical College
• Consistently Filling Sections: Century College, Granite Falls, Dakota County Technical College, Central Lakes College
• Opening Soon, Get on the Waitlist: Alexandria Technical College, Lake Superior College, Northwest Technical College, and Advanced MN

Please visit the Nurse Assistant Training and Testing website for more information and other updates on Nurse Assistant training and testing.

Occupancy Increases Slightly but Held Back by Staffing Challenges

On May 5, 2022 by Jeff Bostic

The Long-Term Care Imperative recently completed an analysis of care center occupancy for the first quarter of this year. Compared to last year, it shows some improvement but nothing close to a return to pre-pandemic occupancy levels.

The statewide occupancy percentage in the first quarter was 76.2%, up from a near all-time low of 75.7% in the final quarter of last year. The recovery is not happening equally across the state, however. In the first quarter, the Twin Cities Metro area and the northern part of the state were all above the state average, while the other rural regions were struggling. The southeast region is particularly suffering right now, setting an all-time low for any area with only 69.7% occupancy in the first quarter.

Staffing shortages are a significant factor in the slow occupancy recovery, and those shortages have been acute for several months now. In Jan., 77.7% of providers reported limiting census because of staffing shortages, which improved slightly this time to 70.6%. Staffing shortages are especially acute in rural areas. In West Central and Southeast regions, more than 80% of care centers reported having to limit census due to lack of staffing.

Assisted Living License Renewals Now Open

On May 5, 2022 by Bobbie Guidry

License renewals for assisted living are now open. The Minnesota Department of Health (MDH) received 115 applications during this first week. If you have not received your renewal information, contact MDH at health.assistedliving@state.mn.us.

MDH has materials to help you prepare your assisted living license renewal application on the MDH website, including:

• ALL renewal application FAQs
• ALL renewal application checklist
• Financial hardship form
• Randomization form

The timeline for license renewal is:

• Renewals began May 1.
• Starting July 1 grace period ends, and fines start ($200).
• After Aug. 1, providers operating without a license will be fined $250 per day.

For support with your assisted living license, contact Bobbie Guidry, Vice President of Assisted Living and Housing.

Advance Care Planning For Gun Ownership

On May 5, 2022 by Bobbie Guidry

In Minnesota, landlords cannot prohibit a tenant from having a legal firearm. This is, at times, a safety concern within assisted living and housing communities. Several tools have recently been developed that may be helpful in related discussions with residents or potential residents.

Colorado researchers published a tool to help gun owners and family members plan ahead for safe firearm use and transfers in the event of disability or death. The Firearm Life Plan kit has four parts that stress personal responsibility, safety, and the importance of being prepared:

• First, the kit lists warning signs (physical, cognitive, behavioral, and emotional) that might cause a gun owner to misuse a gun.
• Second, the guide features conversation prompts for family members and friends who might be concerned about an older gun owner and for older adults who recognize the value of planning.
• The third part is most practical and calls for people to create an inventory of their firearms, where they're stored, who should get the guns when the owner dies or is willing to relinquish them, and when transfers should occur.
• The final component of the guide is a “legacy” section that asks gun owners to share memories and stories about their firearms and what they’ve meant to them.

Another critical tool available for communities comes from the American Foundation for Suicide Prevention. Talk Saves Lives is a standardized 45-to-60-minute education program that provides participants with a clear understanding of suicide with up-to-date research and information on prevention. The effort has content dedicated explicitly to older adults, including risk factors, warning signs, and connecting individuals with support.

For some context to this critical issue:

• 42% of Americans 65 and older live in households with guns
• Up to 60% of people with dementia live in homes with firearms; and
• Among adults ages 50 and older, 84% of firearm-related deaths are suicides
• Older adults tend to plan suicide more carefully. They are also more likely to use more lethal methods.
• Among people who attempt suicide, one in four seniors will succeed, compared to 1 in 200 youths. Even if older adults fail a suicide attempt, they are less likely to recover from the effects.
• Men 65 and older face the highest overall rate of suicide.

Federal News

Reminder: Certain CMS COVID Waivers Expire May 7

On May 5, 2022 by Jonathan Lips

Several of the CMS blanket COVID-19 waivers are expiring on May 7.

In a memorandum released last month, the Centers for Medicare and Medicaid Services (CMS) announced that it will terminate several temporary emergency declaration blanket waivers that have provided nursing facilities and other provider types with flexibilities designed to support the COVID response.

CMS has sorted the waivers ending into two groups: one list expires May 7, and another set expires June 6. To assist members in identifying what waivers are being terminated and when, we have developed a CMS Waivers Termination Schedule. 

The waivers expiring May 7 include:

• Permitting the facility to restrict resident groups from meeting in-person
• Allowing physicians to conduct mandatory visits (e.g., 30, 60-day visits) by telehealth instead of in-person
• Allowing physicians to delegate specific tasks to a physician assistant, nurse practitioner, or clinical nurse specialist that the physician typically would be required to do personally
• Permitting facilities to narrow the scope of the QAPI program to focus on adverse events and infection control
• Waiving the discharge planning requirement that facilities assist residents in selecting a post-acute care provider using data, such as standardized patient assessment data, quality measures and resource use
• Modifying the timeframe requirements to allow LTC facilities ten working days to provide a resident's record rather than two working days

When a given waiver expires, the Minnesota Department of Health will survey for that issue using the standard rule that was in place before the waiver was implemented. We encourage members to review QSO-22-15-NH & NLTC & LSC for the complete list of affected waivers and take the steps needed to return to compliance with the reinstated requirements.

CDC to Streamline Some NHSN Reporting

On May 5, 2022 by Jonathan Lips

In a recent national stakeholder call, the Centers for Disease Control and Prevention (CDC) previewed changes coming to the COVID-19 Long-Term Care Facility module and vaccination reporting module in NHSN. Beginning May 23, reporting in both modules will be streamlined to simplify some reporting.

CDC will be removing some data elements relating to information that has become less important as we learn more and evolve strategies in our national response to COVID-19.

Examples include removal of breakdowns by vaccine manufacturer on data elements related to vaccine status and positive SARS-CoV-2 testing, breakdowns by test type on data elements related to SARS-CoV-2 testing, and streamlining of questions around boosters and “up to date” status.

Data elements related to co-infections and re-infections will be removed. Those related to personal protective equipment (PPE) capacity and staffing shortages will be streamlined into single questions with drop-down modifying questions for those indicating shortages in either person protective equipment or staff.

While CDC has not yet posted details of these coming modifications to the NHSN website, training webinars are planned for mid-May ahead of the changes, and we will watch for those registration links to go live.

On the call, CDC also reminded stakeholders that Event-Level COVID-19 Vaccination Forms are now available in the NHSN application for long-term care facilities to manage person-level vaccination data and simplify summarizing data for weekly COVID-19 Vaccination Modules. 

Use of these forms is optional, and they will replace the Excel Data Tracking Worksheets (also optional) that have been available for some time. The new event-level form requires SAMS 3 access because vaccination status is recorded at the individual level rather than aggregate numbers. Data on the forms carry forward week-to-week to track vaccination status over time. The forms also auto-classify and calculate aggregate numbers and vaccination status.

Care centers may review this Event-Level COVID-19 Vaccination Form Quick Reference Guide and the Training Slides from recent educational events for more information.

Don’t Miss Your Opportunity to Challenge Provider Relief Fund (PRF) Payments

On May 5, 2022 by Jeff Bostic

The Health Resources and Services Administration (HRSA) recently closed Phase Four of the Provider Relief Fund (PRF) payments to health care providers. Now providers are dealing with both reporting requirements and the last opportunity to review what they have received and request reconsideration of the amount or not being paid.

HRSA has added a fifth PRF reporting period, which became necessary because many Phase Four payments were made in 2022, and the original reporting timeline ended at the end of 2021. Funds received in 2022 will have their use reported by Sept. 30, 2023. The next reporting deadline is Sept. 30, covering funds received in the first half of 2021.

Providers who do not believe their Phase Four PRF payment was calculated correctly can review how those were determined and submit a reconsideration. Providers denied funding in Phase Four because they were not verified as a known provider can appeal that determination. The PRF FAQ provides information on that, and many of the reporting questions providers will be dealing with over the next several months.

Notable News

Safe Care Begins with You in 2022

On May 5, 2022 by Julie Apold

After over two years of COVID-19, we invite you to join us in the latest Safe Care Living the Pledge activity, called “Living the Pledge Every Day.” In a few weeks, we will share easy-to-use tools and resources to refocus on the key components of the Safe Care Pledge through monthly activities that you can bring to your community. They will help your organization celebrate and renew your commitment to respect, dignity, safety, and quality of life for those we serve.

Safe Care Pledge

I pledge to do my best every day to increase the safety of the people I serve and my fellow team members by: 1) I will always treat the people in my care with respect and dignity and take steps to get to know them as a person; and 2) I will speak up if I see something that may be unsafe or makes me feel uncomfortable.

Calling All Safe Care Champions

If you are a Safe Care organization, to receive the latest news and resources, please make sure that our team has the name of your Safe Care Champions by using this form.

If your organization is new to Safe Care, we invite you to identify a Safe Care Champion for your community by using this form. We will help them get training and tools to get started.

More than 450 member sites have committed to Safe Care since 2019. It is a comprehensive approach that provides the structure and support for individuals and organizations to keep those they serve safe from harm and to provide care with respect and dignity always. This starts with an individual pledge, followed by organizations pledging their commitment to implement actions within their organizations with support from LeadingAge Minnesota and shared learning with peers. 

Look for more details about the “Living the Pledge Every Day” resources and activities in future newsletters. For more information, please contact Julie Apold.

Celebrate National Nurses Week and Month this May

On May 5, 2022 by Anna Mowry

Every year, the American Nurses Association (ANA) celebrates National Nurses Week, May 6-12, to promote, support, and honor the varying roles of nurses and the positive impacts they make in our communities every day. This year, ANA expanded National Nurses Week to National Nurses Month in May to show gratitude for the invaluable contributions of nurses all month long.

The 2022 National Nurses theme is "Nurses Make a Difference." The month will be divided into four weekly focus areas: Self-Care, Recognition, Professional Development, and Community Engagement.

Week 1: Self-Care (May 1–7)

This week is focused on cultivating and maintaining the optimal mental and physical well-being of nurses. In a profession where you are focusing on the care of others, it can be challenging to find the time and energy to focus on yourself. See below for some ideas on how to get involved this week.

• Create an environment where everyone doesn’t just survive – but can thrive. Visit the Self Care for Safe Care site to find easy-to-use resources and activities to help retrain our minds to focus on the positive and increase our sense of happiness and well-being.
• Promote and inform your employees of your organization's well-being resources, tools, employee assistance programs, and other benefits they have.
• Encourage your staff and yourself to spend some time outside to increase your vitamin D levels to boost your immunity, decrease anxiety, and improve sleep.
• Challenge yourself, your colleagues, family, and friends to engage in healthier activities throughout the week!

Looking Ahead

Week 2: Recognition (May 8–14) Honor the work of nurses whose impacts are vital to the health of our communities and the future of health care.

Week 3: Professional Development (May 15–21) Promote the professional

development of nurses to help inspire and lead others in their nursing career journey.

Week 4: Community Engagement (May 22–31) Educate your communities on the vital role nurses play and how they can get involved to support our current and future nurses.

For more resources and to learn more about how you can participate in National Nurses Week and Month, visit the National Nurses Month webpage.

Celebrate How Seniors “Age My Way” During Older Americans Month

On May 5, 2022 by Libbie Chapuran

May is Older Americans Month (OAM), a national celebration established in 1963 to acknowledge the contributions of past and current older persons to our country, in particular those who defended the nation. We celebrate and honor older adults and all their contributions every day.

And we will contribute to this national observation by spotlighting how our clients and residents Age My Way, the 2022 OAM theme. We’ll also exemplify our mission as we lift our voices to help ensure all older adults can enjoy their right to essential services as they age.

Want to join our celebration? Follow along on social media to participate virtually or engage in any of the ways below:

• Share the LeadingAge Choices video:
  • Share now on Facebook
  • Share now on LinkedIn
  • Retweet now on Twitter
  • Share now on Instagram 
• Ask your Members of Congress to support policies to ensure older adults can age their way—then share the Action Alert. 
• Schedule or share social media posts throughout May, including the second Video Share Day on May 24, featuring Life Changes. LeadingAge's social media toolkit can help!
• Publish this Older Americans Month article on your website, blog, or newsletter.
• Display posters on community bulletin boards. Easy-to-use print assets are here!

Learn more about LeadingAge’s Older Americans Month plans now. Thank you for all you do to support older adults as they “Age My Way!” 

Member News

Annual Membership Survey: Feedback Requested by May 27

On May 5, 2022 by Luke Jenkins

We respect and value your opinion, and we ask you to share your thoughts in our 2022 Annual Membership Survey.

Looking back at the past two years, we can all agree it hasn’t been easy. We faced a global pandemic head-on and continue to work together to address the ongoing impacts of COVID-19 and the severe workforce crisis plaguing our settings. But we also must look ahead. Minnesota is now home to one million seniors, and we are seeking new, innovative ways to serve all those who need care in our settings.

The information you share in this survey will help us assess how we have done in our service to you, our members. It will also help us see more clearly what lies ahead as we map our strategic priorities, develop new programs, and focus our work to support you in your service to older adults.

We would be grateful if you would take a few minutes to complete this survey by May 27. It is designed to be fast and straightforward. Please allow 5-7 minutes to complete it.

Responses are anonymous, so if you would like us to follow up or if you just prefer to share your thoughts in person, please contact our Director of Membership, Luke Jenkins, at 651-328-4221.

LeadingAge Minnesota Education Solutions

Register Today - 2022 Nurse Leadership Certificate Program Starts May 17

On May 5, 2022 by Heidi Simpson

Registration closes soon for LeadingAge Minnesota’s Nurse Leadership Certificate Program – the premier training program for new and emerging nurse leaders in skilled care and assisted living settings. The series begins May 17 and is scheduled over five months, including in-person and virtual sessions.

A 30+ year track record of developing nurse leaders in our field precedes this year’s program. It prepares newer leaders to fully understand the scope and responsibilities of the role and build the skills that are essential to their success and the success of their organization.

Key topic areas include:

• Understanding and growing into the role of the professional nurse leader
• Leading a team, managing change, preparing for surveys
• Learning all about budgets and reimbursement, clinical and quality processes, and human resources management

Here’s what one participant of the 2021 program had to say about the experience:

“Thank you for providing this truly beneficial opportunity. I feel like it will absolutely change my career as well as outcomes for the residents in my community.” -Karla Evenson, Director of Nursing, The Glenn Minnetonka

This exceptional program is offered only once a year, so reserve your spot today.

The Nurse Leadership Certificate Program is facilitated by Kari Everson, LeadingAge Minnesota's Vice President of Clinical Services and Nurse Consultant, joined by a host of seasoned professionals in the field serving as program faculty.

LeadingAge Minnesota acknowledges and thanks Silver Annual Sponsor Thrifty White Pharmacy and Bronze Annual Sponsor St. Croix Hospice for sponsoring this program series.

Find complete details and register here.

Other Meetings and Events

Just Two Weeks Until Argentum Conference in Minneapolis

On May 5, 2022 by LeadingAge

There is still time to register for the Senior Living Executive Conference happening May 16-18.   

Thousands of senior living professionals, operators, owners, executives, and community leaders will gather in Minneapolis, Minnesota, for the next edition of the Senior Living Executive Conference & Expo, the official meeting of Argentum.

They have designed an elevated educational experience that recognizes the unique challenges facing senior living professionals today. This is your chance to connect face-to-face with a community of peers who have re-emerged resilient. You'll also exchange information on the latest policy developments, explore emerging issues, and hear from experts who understand what the future holds for the senior living space.

Register today! Here is the code in case you would still like to register and save $100: SP100

Please connect with Kari Horesky from Argentum or Luke Jenkins at LeadingAge Minnesota for more information.