It’s not that Jennifer Gwin and her sister were caught unaware by their mother’s Parkinson’s disease.
They’d been preparing and researching future options. Their mother, in her early 80s, was still living in an apartment and getting help with housekeeping chores while sorting through her things in anticipation of an eventual move.
But when her condition suddenly worsened last fall, her family had to scramble, Gwin said. Insurance wouldn’t agree to a longer rehabilitation stay in a skilled nursing facility, and it was unsafe for their mother, whose name the Post withheld for privacy reasons, to live without more care.
They had no more than two weeks to figure it out, while at the same time appealing the insurance company’s decision, she said.
“We knew this would be coming,” said Gwin, who lives in the Boston area. But the suddenness of her medical issues took them by surprise. “We just didn’t think it would come quite as quickly as it did.”
Things eventually worked out. Gwin’s mother’s condition stabilized, and she moved into a small assisted living setting in Overland Park with a private room where she is thriving, Gwin said.
It was a good outcome that might not have happened without a lot of help from experts, she added.
“The rebirth of the nursing home”
Families throughout Kansas are finding themselves in similar situations because of complex and interconnected events that continue to afflict the senior care industry, say the founders of CareStreet, an Overland Park senior placement service that helped Gwin’s mother.
A continuing labor shortage, aggravated by the COVID-19 pandemic, plus swelling numbers of baby boomers aging into care, have pushed and pulled at a complicated system few family members are prepared for, said Matthew White, CareStree’ts co-founder.
Demand has driven more new facilities to open, but at the same time, the number of people willing to work in them has remained flat, he said. As a result, facilities that previously had robust staffing try to get by with less, and the types of services they can provide become more limited.
A good example of this is the Hoyer lift, he said. The framework of the Hoyer helps caregivers lift patients who can’t make it in and out of bed on their own. To avoid liability issues, nursing facilities may require two people to do the transfer to a wheelchair. But given staff shortages, they may be reluctant to provide that service, he said.
In some cases, care facilities that used to be able to use the lifts withdraw that service and ask families to hire someone to come in for that, said Jerry Pullins, another of CareStreet’s founders. Other times, a person who had been getting around without help suffers a decline and suddenly needs it.
Either way, the result is the same. Families suddenly find themselves facing a deadline to either pay much more or find another place to live, and the search for an appropriate living space can be especially daunting since there’s such a wide range of care options to consider, Pullins said.
“If I wrote an article, it would be called ‘The rebirth of the nursing home,’” he said.
Family members, facing a deadline, may feel they have little choice but to agree to placement in a skilled nursing bed.
“Everyone is being pushed towards what would be called long-term care or nursing home or skilled facility,” he said.
Kansas could do better, experts say
One statistic by the American Association of Retired Persons shows more than “80% of folks 65 and older say they want to age in place.”
It is a statistic Dan Goodman, executive director of Kansas Advocates for Better Care said he often relates when speaking to people. But Goodman, who is also former director of the Johnson County Area Agency on Aging, said he also adds a qualifying line: “In more than 30 years, I still haven’t met that 20% that say, ‘I can’t wait to get into a facility.’”
“What we’re doing to older adults is we’re forcing them prematurely into facilities to receive poor care, is what we’re doing,” Goodman said. “I think we could do a lot better.”
That’s not to say plenty of good people aren’t trying. But the trouble is, Kansas hasn’t done a good enough job of balancing support for long-term care versus smaller, more independent community care, Goodman said.
The Kansas Legislature has been generous in funding the nursing home industry, especially since the pandemic, he said. It hasn’t been particularly effective, though, in solving one of the industry’s most stubborn problems — staff shortages.
A 2022 report by Seniorly, a San Francisco-based company that provides online tools in senior living searches, put Kansas fourth in the nation for staff shortages in long-term care facilities. Kansas was behind Minnesota, Washington and Maine.
The same report showed half of Kansas’ long-term care facilities reported shortage of nursing staff, and 54% had trouble getting enough aides.
The problem is Kansas funding increases have not been tied to outcomes, Goodman said. He suggested financial support be linked with a demonstrable outcome, such as staying fully staffed for six months.
Staffing has also been a problem for senior living on the next tier down, where residents don’t need physical assistance for eating, toileting and moving, Goodman said.
Even for people trying to live independently, a shortage of community support in the form of home helpers can make the difference in staying out of long-term care. Too often, Goodman said, there are hiccups and gaps in these at-home services that can result in hospitalization and general decline.
“It’s always easier to find an empty Medicaid bed at that facility than it is to coordinate care to go back home,” Goodman said. “If we ever get to the point that it’s easier to get them home with coordinated care than to find an empty Medicaid bed, we will really have done something for older Kansans.”
COVID-19 worsened staffing issues
It’s always been hard to find people willing to be paid caregivers, said Tim Wholf, director of Johnson County Aging and Human Services. And it’s only gotten worse since the pandemic.
Among other things, Wholf’s agency helps people find aides to do light house cleaning and help with bathing and chores.
Caregiving and homemaking positions like those don’t require a degree or experience, he said, so the pay is usually on the low side, maybe as much as $13 or $14 an hour, he said.
As the country began to emerge from the pandemic, though, other employers in that pay range began to raise their wages.
“If you think about going into part-time work taking care of somebody, you may get a few hours here and a few hours there if you make $13 or $14 an hour. You can go to a retail store or fast food and can make $15 or $18 an hour and guaranteed hours,” he said. “It’s definitely harder to fill positions now.”
Goodman adds, “It isn’t just money. It’s also culture. Direct care is hard work,” physically, mentally and emotionally. “But we reward the people willing to do that work with rock-bottom benefits. We need to change our mindset about folks that provide that care.”
COVID also caused a lag in accreditation, as the state paused certification of nursing aides, White said. That, combined with retirements, created a significant labor shortage that has also contributed to increases in the cost of care.
“The right question”
Meanwhile, the population Kansas — and the U.S. more broadly — is aging rapidly.
In the U.S., the population 65 and older grew at its fastest rate since the 1880s. The Administration for Community Living quotes U.S. Census Bureau figures showing nearly a quarter of Kansas inhabitants will be over 60 by the year 2030.
So is it possible the country will run out of bed space of all kinds?
White calls that, “the right question nobody else is asking.
“Look at this bell curve of baby boomers,” he said. “By the year 2030, there’s going to be a significant uptick in the need for some of these beds. We’re seeing a lot of new communities joining the landscape. But I don’t know that we have enough caregivers and enough nurses. That’s a whole separate conversation.”
“The challenge,” White added, “is that most consumers don’t think about senior living and care until they’re confronted with it.”
Roxie Hammill is a freelance journalist who reports frequently for the Post and other Kansas City area publications. You can reach her at roxieham@gmail.com.
