WICHITA, Kansas — Kansas finds itself in a budding nursing home crisis.
A lack of workers and money troubles forced dozens of nursing homes and assisted living centers to close their doors during the pandemic, and more look doomed to follow.
Homes that remain open stand more than twice as likely to see staff shortages as the country overall.
Meanwhile, Kansas falls deeper into a demographic spiral with a fast-aging population and a lack of young people to take care of them. By 2036, the number of Kansans 65 years and older is projected to grow by more than 40%.
Already, 35 long-term care facilities closed or downsized during the pandemic, according to new report by nonprofit aging services providers group LeadingAge Kansas.
The biggest reason, say nursing home operators, is a shortage of staff.
“For every person we hire, it seems like two are leaving,” said Heather Pilkinton, an administrator with Evergreen Community of Johnson County in Olathe.
The nursing home recently closed one fourth of its residential capacity because it couldn’t find enough workers. Pilkinton said that over the past year, around 20 of their 51 certified nursing assistant positions have remained unfilled.
Last week, the Apostolic Christian Home in Sabetha got into a bidding war with a nearby hospital over workers, said executive director Ed Strahm.
“Our staff is very much aware that they are in high demand,” he said. “It makes it a real challenge to stay competitively priced to the end customer.”
A similar story is playing out across the state.
An AARP analysis found that, for the past 12 months, over half of Kansas nursing homes saw a shortage of direct care workers. Shortages have outpaced the national average at least since early in the pandemic. Now the shortfall in Kansas is more than twice the national rate.
The costs for residents are tangible. When workers are in short supply and turnover is high, research shows patients tend to lose weight and get more pressure sores, and COVID-19 spreads more rapidly.
If a nursing home can’t hire workers on its own, it might turn to a staffing agency to supply traveling nurses and nursing assistants for months-long contracts or one-day assignments.
But those private agencies charge much more than what the nursing home would pay to hire that same worker full-time. Part of the money goes to agency nurses in the form of higher paychecks, but a big chunk — sometimes nearly half — stays with the agency.
Across the health care industry, reliance on staffing agencies exploded during the pandemic as an already-dire shortage of nurses worsened. And as demand went up, travel nurse salaries ballooned.
Temporary state and federal aid during the pandemic helped medical providers shoulder those costs, but that money is running out.
Now Kansas nursing home administrators want lawmakers to further regulate staffing agencies that they say are gouging prices.
“Nursing homes can’t sustain that,” Pilkinton said.
A growing dependence on agency nurses creates unique concerns in long-term care environments where elderly residents often crave consistency.
“It’s really difficult to have a different person caring for you all the time,” said Dana Weaver, the chief operating officer of LeadingAge Kansas. “It produces anxiety for the individual, and the individual actually has to teach the agency staff person how to care for them.”
But for many nurses, the decision to join a staffing agency comes down to a simple reality: they can make more money doing the same work. Certified nursing assistants, among the most common medical staff in nursing homes, earn a median income of $30,000 per year and often work multiple jobs to make ends meet.
Rebecca Givan, a professor of labor studies at Rutgers University, said the sudden growth of staffing agency costs raises questions, especially as investors rushed into the industry during the pandemic. But she said administrators could take steps to reduce their reliance on agencies.
“The way to do that is to pay them more,” she said. “And, often, these facilities don’t want to pay them more — but then they’re actually paying multiple times that out to the agencies.”
Givan said administrators should also think more holistically about how to improve working conditions.
“It means pay, but it also means voice,” she said. “It means if they’re unionized or want to unionize, not resisting.”
Robert Livonius, a former chairman of the American Staffing Association who sits on the boards of multiple health care staffing agencies, said “some bad actors … popped up during the pandemic period and took advantage of the situation, raised prices.”
“Those people,” he said, “should be taken out of the industry.”
But he said agencies aren’t to the blame for the bigger problem: a systemic lack of health care workers.
“There is a very acute shortage of enough certified nursing assistants and nurses to work in long-term care,” he said. “That problem was there before the pandemic, and it’s just been exacerbated.”
Rose Conlon reports on health for KMUW and the Kansas News Service. You can follow her on Twitter at @rosebconlon or email her at conlon@kmuw.org.
The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.
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