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Missouri and Illinois nursing homes rank last in hours of care residents receive

Since March, 3,762 nursing home residents in St. Louis County have contracted the coronavirus and 593 have died, accounting for nearly 60% of all COVID-19 deaths countywide.
Nat Thomas
St. Louis Public Radio
An analysis of federal Medicaid data shows Missouri and Illinois rank last in the nation in hours of care nursing home residents receive from workers each day.

Missouri and Illinois rank last in the nation in the hours of care nursing home residents receive from nurses, according to a New York nonprofit that analyzes nursing facilities.

The reportfrom the Long Term Care Community Coalition, found that on average, nursing home residents in Missouri and Illinois received just under three hours of care a day from nursing home staff. The national average is 3.62 hours of care per day.

The low level of care points to a shortage of nursing home employees, said Marjorie Moore, executive director of VOYCE, a Missouri nonprofit that advocates for families of nursing home residents.

“A lot of these residents need help either getting to the bathroom or need help with changing their diapers because they're incontinent, a lot of them need help washing,” Moore said. “You can imagine how many hours all of those things take a day, I would imagine that it takes several hours to do all of those things.”

A 2001 report by the Centers for Medicare and Medicaid Services found that nursing home residents needed a minimum of just over four hours of care a day to meet a patient’s clinical needs. The low amount of care is tied to nursing home staff shortages that have long plagued the state, even before the coronavirus pandemic.

“We need to find ways to be able to pay long-term care workers better, to be able to attract and retain really high-level talent,” Moore said. “It's one of the most important places that nurses and CNAs and techs can go into, because you're caring for people who have spent their lives caring for us.”

The report comes on the heels of several new proposals introduced by the Biden administration last week for skilled nursing facilities across the country. The proposals include setting minimum staffing standards for nursing homes.

The proposals are a big step forward in ensuring homes are better suited for taking care of patients, said Richard Mollot, executive director for the Long Term Care Community Coalition.

“These are by far the most important proposals since the federal nursing home law was signed in 1987,” Mollot said. “I think it can go a long way to addressing some of the failures that we've seen in the ensuing 35 years since the '87 law went into effect.”

The administration’s proposals also would scrutinize nursing homes owned by private-equity firms, which Mollot said has led to substandard conditions at many homes and higher medicare costs. The administration also announced plans to crack down on the nation’s poorest-performing nursing homes. Other planned measures would make it easier for the public to evaluate the quality of nursing homes.

“Some of these poor performers are also continuously buying up other facilities at the same time saying that they don't have enough money to pay staff appropriately,” Moore said. “That provides us with a little bit of dissonance going, you can buy facilities, but you can't pay the staff in the facilities you have and that just doesn't make a lot of sense.”

Moore said the proposals could greatly improve homes across the state.

But representatives of the American Health Care Association, a nonprofit group that represents nursing homes, said more needs to be done to address Medicaid underfunding and to ensure nursing facilities can meet the administration’s staffing requirements.

“Increasing staffing minimums in the midst of this workforce crisis without corresponding resources does little to help residents and would result in nearly every nursing home being out of compliance,” Mark Parkinson, president and CEO of the American Health Care Association and the National Center for Assisted Living wrote in a Tuesday letter addressed to U.S. Health and Human Services Secretary Xavier Becerra.

Mollot said in an interview that low wages and the inability for nursing home workers to move up the career ladder are contributing factors to the labor shortage, but that working conditions for nursing home workers need to be improved.

“What we hear most of all from workers over the years is that the working conditions in nursing homes are oftentimes abominable,” Mollot said. “Nursing homes as a whole are short staffed, and that kind of forces the staff to cut corners to take shortcuts, and those shortcuts can be dangerous for both the residents and the staff themselves.”

Follow Chad on Twitter: @iamcdavis


Chad is a general assignment reporter at St. Louis Public Radio.