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Nursing bed surplus projected, but staffing concerns loom

Katie Tabeling
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A recent projection of nursing home beds indicates there will be a potential surplus of 286 beds, but since the patient to staff ratio is bound by law, it’s not clear what may happen if staffing numbers continue to fall. | PHOTO COURTESY UNSPLASHED/ONLINE MARKETING

WILMINGTON — Delaware’s three counties are predicted to have a nursing bed surplus in the next five years, but with the struggles of attracting and keeping skilled nurses may prove to be a more immediate issue at hand.

In May, the Health Resources Board heard and adopted the Delaware Nursing Home Utilization Statistical Report. That report shows that the state will have a surplus of 755 beds in private and public nursing homes by next year. Fast forward to 2027, that surplus will be 286 beds. 

The First State ranks among the top ten of occupancy rates per capita in nursing homes —  today, the occupancy rate is 77% compared to the nationwide average of 73% according to the American Health Care Association (AHCA).

Nursing homes are bound by staff-to-patient ratios, and Delaware maintains one of the highest in the region at  3.28 hours of direct care per patient. The COVID-19 pandemic accelerated nursing facilities employees to leave the field; between 2018 and 2021 856 nurses left the profession. At the same time, home health care gained 465 employees – and now outpaces nursing facilities staff.

“We’re not sure the extent of staffing shortages impact on the patient census. If some facilities are open, and lowering the number of patients they can see, it’s not going to be reflected in these numbers,” Dr. Allison Shevock told the Health Resources Board (HRB) in May. “It’s an important factor to consider when we think about the strangeness of 2020 and 2021, and possibly as we go into the future.”

The report

As of today, 45 Delaware nursing homes operate a maximum of 4,868 licensed beds. Foulk Manor South in Wilmington and the Weston Center at Highfield both closed in June, while Forwood Manor Nursing Home stopped offering nursing care. Luther Towers in Wilmington and Governor Bacon Health Center also closed at the start of the pandemic.

In 2021, Delaware had 9,260 patients in private nursing homes admitted —  20% less than the decade before. Timed with COVID-19,  admission rates dropped to 8,205 in 2020, and the patient enrollment is slowly rebounding to date, according to the state’s report.

New Castle County, with 25 nursing facilities, saw admission rise by almost 3%. Kent County saw admission increase by 31% and 23% in Sussex County.

Total discharges last year slightly increased to 8,583 patients, and more than 50% were sent back to their homes. Discharges from private facilities slightly dipped in New Castle County, but in southern Delaware, the rate increased by 5%. Kent County had the highest discharge rate recorded at 24%.

Statewide, admissions rose 12% while discharges dropped by 2% in the last two years. But the data from billable patient days —  or how a facility measures how long it is caring for patients or how many patients it’s seeing — suggests that patients may be staying for shorter periods.

Over the course of a decade, billable patient days have continued to decline. In 2021, the 45 facilities recorded 1.2 million billable patient days and a 72% occupancy rate, roughly a 4% drop from the previous year.

Outside data

Delaware is an aging state, with the Delaware Population Consortium showing that the residents ages 65 and 69 will rise by 16% by 2050. In that same time frame, the consortium projects that the state’s population will rise by 93%.

But reports the ACHA has shared with its members suggests that nursing homes are facing unprecedented challenges with negative operating margins – as many were supported by federal COVID-19 funding programs – and slow occupancy rebounds, hindered by public messaging for people to stay home during the pandemic when possible.

A report conducted by Clifton Larson Allen LLP on behalf of the trade association shows that 36% of Delaware’s skilled nursing facilities are operating at financial risk, crossing all three counties. Risk was defined as a “greater than a negative 7.5% operating margin.” 

Home health is also becoming a more popular option for care as well as employment. The state’s report shows that 4,720 patients were discharged to their home in 2021. In the last two years, major hospitals have started to move away from the doctor’s office and to the patient’s bedroom. Beebe Healthcare launched a hospital at home service. ChristianaCare signed a deal with Seasons Hospice & Palliative Care of Delaware to offer at-home hospice last year as well.

In 2020, home health nurses for the first time outnumbered nursing facility employees in the First State. The Bureau of Labor Statistics show 4,548 employees in home care, compared to 4,041 in nursing facilities. That gap has only grown wider in the last two years.

“Nursing homes haven’t bounced back their staffing numbers, but home health did grow over time. That’s a valuable resource in our community, as it’s used in assisted living settings as well as group homes,” Delaware Health Care Facilities Association Executive Director Cheryl Heiks said during the May 26 HRB meeting  “But the problem is that it adds to the workforce shortage. Home health aides can take care of one person, compared to half the people in a building.”

Nationwide, nursing homes have been struggling to retain talent, with turnover for registered nurses, licensed practical nurses, and certified nurse aids ranging between 41 to 54%, according to the 2022-2023 Hospital & Healthcare Compensation Service Nursing Home Salary & Benefits Report.

Pay increases for registered nurses and certified nurse aides are around 11%. At least half of the nursing homes that participated in the study reported paying sign-on bonuses. The average sign-on bonus for a registered nurse is $4,566; the average sign-on bonus for licensed practical nurses was $3,494; and for certified nurse aides was $2,146. 

When interviewed by the Delaware Business Times, Heiks noted that the pandemic accelerated a workforce departure for nursing homes, which may leave many facilities in the position of not accepting residents because of staffing requirements as well as looking to maintain strong standards of care.

“Facilities are struggling to come to the other side, and this environment may look a little different than it did before, even with dramatically increased wages,” she told DBT. “We’ve seen changes in flexibility and bonuses, and it still hasn’t been able to keep staff here. We need to work with the state and other stakeholders to build that workforce.  And not just for us, but for the rest of the healthcare continuum because it is a circle – we’re all drawing from the same source.”

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