The Centers for Medicare and Medicaid Services is proposing a rule that would require nursing facilities to have registered nurses on staff 24 hours a day. While this might sound like a good idea, the truth is Idaho doesn’t have enough nurses to make it happen, writes guest columnist Robert Vande Merwe. (Getty Images)
Idaho’s health care system faces a serious challenge, and it’s not just about doctors. The entire health care workforce is stretched thin. This workforce shortage affects all of us, and we need to find solutions now before it gets any worse.
Let’s focus for a moment on one just part of this system-wide problem: Idaho’s nursing shortage. Our state is ranked 50th in the United States for the number of nurses per capita, with just 7.83 registered nurses per 1,000 people. With so few nurses, hospitals, nursing facilities and other care facilities are all competing for the same small pool of talent. As the need continues to grow, nurses will get poached from one place to another, leaving even more gaps in care everywhere.
Partnership links College of Eastern Idaho’s nursing programs, local hospitals through institute
This shortage is already causing real problems. Since the pandemic, Idaho has lost one nursing facility, 30 assisted living facilities and other providers are on the verge of closure. When facilities close — especially within rural communities — it’s the patients and their families who feel the greatest effects.
Families are forced to drive dramatically longer distances that can add up to an hour each way just to see their loved ones. If more facilities close, more families will face this same hardship. Instead of daily visits, trips to see loved ones might be reduced to just one or two times per week because of the time and cost associated with these trips.
Idaho has only 80 nursing facilities in the entire state with about 6,000 beds available to our population that requires this specialized care. Some nursing facilities in Idaho licensed for up to 150 beds but only care for about 80 patients because they can’t hire enough staff to care for more.
Hospitals don’t have enough nurses either, but they experience the nursing shortage in others ways too. It’s common to hear of patients that needlessly remain in hospitals when they’re ready to be discharged to a nursing facility — but can’t be discharged because a staffed bed is not available. These patients don’t belong in a hospital.
They could end up getting sicker, feel disoriented or lose their spirit. Everyone agrees they’d be better off in a nursing facility, but there’s just no room for them without more nurses. Some patients have stayed in hospitals for an extra 200 days because they have nowhere else to go. And in most cases, these extended stays are not reimbursed to the hospital.
This nursing shortage isn’t something we can fix overnight. It’s going to take years, even decades, to get enough nurses trained and working. But with every new nursing graduate getting multiple job offers, it’s tough to fill the gap.
Things may get worse for Idaho nursing facilities before they get better.
The Centers for Medicare and Medicaid Services is proposing a rule that would require nursing facilities to have registered nurses on staff 24 hours a day. While this might sound like a good idea, the truth is Idaho doesn’t have enough nurses to make it happen. Most facilities have an RN on one shift and LPNs when an RN is not clinically necessary.
If the CMS rule goes into effect, the options will be grim for many Idaho facilities. Either pay sky-high rates for traveling nurses, which Medicaid won’t fully cover, or close their doors for good.
At the Idaho Health Care Association, we support the idea of better patient care, but this rule isn’t possible without major changes. We need to ensure our nursing facilities have enough staff to provide the care that Idahoans deserve. That’s going to require action from the state and federal government, Idaho’s education institutions, and private health care establishments.
If we don’t act now, we risk losing more nursing facilities and leaving even more families without the care they need.
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