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Pleasant View Home draws its shuttersWorker shortage, low Medicaid rates push wave of rural care facility closures

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A confluence of staffing shortages and problems with the managed care organizations that administer Iowa’s Medicaid program prompted Pleasant View Home in Albert City to close its doors. 

The nursing home announced its upcoming closure in a statement last Friday. Colleen Miller, board president of Albert City Improvement Corp., announced the facility won’t accept new admissions. 

Over the next 60 days, the facility will work with residents and their families to find another facility that will meet their care needs. 

“Although this has been a difficult decision, with the ongoing workforce shortages across rural Iowa and the escalating inflationary environment, we were no longer able to compete for the staff needed to remain open,” Miller said in the nursing home’s statement. “Pleasant View Home will continue to support our residents and their families in the process of finding a new home. Our goal is to make the transition as smooth as possible.”

The facility has been open for 58 years; it serves 21 residents and employs 29 staff. 

The nursing home’s problems can be attributed chiefly to a lack of workforce, according to Lisa Lowe, the administrator of the nursing home. Before the coronavirus pandemic, the nursing home’s full-time staff numbered at around 30. It only employs around 15 full-timers at present. The facility was hit by an industry-wide staffing exodus from long-term care, Lowe explained. Staffing at nursing care facilities, the most severely affected employment sector from the coronavirus pandemic, has decreased 13.3%, according to Kaiser Family Foundation’s Health System Tracker. 

For Pleasant View, the staffing shortage was particularly severe. Albert City is at least 25 miles away from a regional center like Storm Lake or Spencer. As the workforce exodus worsened, Pleasant View had problems luring skilled care workers from larger areas that also had facilities that were struggling with staffing.

Even when Pleasant View found help, it was nearly impossible to find housing, Lowe added, because Albert City doesn’t have any available. Nearly all of the housing growth over the last decade has been concentrated in Storm Lake and Alta, the only two communities in the county with skilled nursing care facilities.  

“It’s a lack of workforce issue,” said Lowe on Monday. “We just couldn’t find anyone. It was a location issue.”

Pleasant View is the second of Buena Vista County’s nursing homes to close in the last nine months; Newell Good-Samaritan Society closed last May. Over the last year, 17 skilled nursing facilities in Iowa have closed, according to Brent Willett, president of the Iowa Health Care Association.

Pleasant View’s closure follows a six-year trend of area nursing home closures since former Gov. Terry Branstad privatized Iowa’s medicaid system in 2015. 

It prompted the closure of North Lake Manor and a host of others. 

Willett noted the health care system’s operating costs have exploded since the pandemic; Medicaid rates paid by the state haven’t kept up. Lowe estimated the managed care organizations were reimbursing Pleasant View for roughly three-quarters the cost of care. 

“Reimbursement had something to do with it,” said Lowe when asked about the nursing home’s experience since Medicaid privatization. “Before they would hold our money. They don’t do that anymore. But they give us around 70% to 80% of what our services actually cost.”

Willett claimed the nursing home industry in Iowa is on an “unsustainable trajectory” given the hastening rate of closures. In response to Pleasant View’s closure, Willett called on the Legislature to lift Medicaid reimbursement rates to reflect the rising cost of care. 

“Iowa skilled nursing facility providers are today incurring ongoing and devastating financial losses,” Willett said in a statement on Monday. “For every dollar spent to care for an Iowa Medicaid resident, the system currently reimburses providers 80 cents.”

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