WAUKON, Iowa — Marjorie Kruger was shocked to learn last fall that she would have to leave the nursing home where she had lived comfortably for six years.

The Good Samaritan Society facility in Postville, Iowa, would close, administrators told Kruger and 38 other residents in September. The facility joined a growing list of nursing homes that have been closed across the country, especially in rural areas.

“The rug was pulled out from under me,” said Kruger, 98. «I thought I would stay there for the rest of my life.»

Her son found her a room at another Good Samaritan center in Waukon, a small town 18 miles north of Postville. Kruger said the new facility is a nice place, but he misses his friends and employees from the old one. “We were as close as a good family,” he said.

Former residents of the Postville facility are scattered throughout northeast Iowa. Some were forced to move twice, after the first nursing home they transferred to also closed.

The Good Samaritan Evangelical Lutheran Society nursing home in Postville, Iowa, closed in November. It was the only nursing home in the city of 2,500 and one of at least 15 care centers that closed in Iowa last year.Tony Leys/KHN

The owners say the closures are largely due to a shortage of workers, including nurses, nursing assistants and kitchen workers.

The problem could deepen as pandemic-era government assistance dries up and call centers struggle to compete with rising wages offered by other employers, industry leaders and analysts predict. Many care centers that have managed to stay open are keeping some beds vacant because they do not have enough workers to responsibly care for more residents.

The pandemic brought billions of additional federal dollars to the long-term care industry, which was inundated with covid-19 infections and more than 160,000 resident deaths. Many facilities saw business decline amid closures and reports of outbreaks. Staff members faced additional danger and stress.

The industry is still feeling the effects.

From February 2020 to November 2021, the number of workers in nursing homes and other care facilities dropped by 410,000 nationally, according to the federal government. Bureau of Labor Statistics. Staffing has only rebounded to around 103,000 since then.

In Iowa, 13 of the 15 nursing homes that closed in 2022 were in rural areas, according to the Iowa Health Care Association. «In less populated areas, it’s increasingly difficult to staff those facilities,» said Brent Willett. , president of the association. He noted that many rural areas have dwindling numbers of working-age adults.

A lack of open nursing home beds is leaving some patients stranded in hospitals for weeks while social workers search for locations. More and more people end up in care facilities far from their hometowns, especially if they have dementia, obesity, or other conditions that require extra care.

Kim Bimestefer, Colorado’s executive director of health care policy and financing, said a conference in november that the state recognizes that it needs to help shore up care centers, especially in rural areas. “We had more nursing homes fail in the last year than in the last 10 years combined,” she said.

In Montana, at least 11 nursing homes, 16% of the facilities in the state, closed in 2022. reported the Billings Gazette.

At the national level, the Centers for Medicare & Medicaid Services Informed recently that 129 nursing homes closed by 2022. Mark Parkinson, president of the American Health Care Association, said the actual count was significantly higher, but federal reporting tends to lag behind what’s happening on the ground.

For example, a recent KHN review showed that the federal agency had counted just one of the 11 media-reported Montana nursing home closures in that state during 2022, and just eight of the 15 reported in Iowa.

Demand for long-term care is expected to increase over the next decade as the baby boom generation ages. Willett said his industry supports changing immigration laws to allow more workers from other countries. “That has to be part of the solution,” she said.

The nursing home in Postville, Iowa, was one of 10 care centers closed last year by the Good Samaritan Society, a large South Dakota-based chain.

“It’s absolutely a last resort for us as a nonprofit that in many cases would have been in these communities for 50 to 75 years or more,” said Nate Schema, the company’s chief executive officer.

The Evangelical Lutheran Society of the Good Samaritan, the full name of the company, is affiliated with the giant Sanford Health network and serves 12,500 clients, including residents of care centers and people receiving services at home. About 70% of them live in rural areas, mostly in the Plains states and the Midwest, Schema said.

Schema said many frontline nursing home workers found less stressful jobs after working during the worst days of the Covid pandemic, when they had to wear extra protective gear and routinely get tested for infections at risk. continuous.

Lori Porter, executive director of the National Association of Health Care Assistants, said staffing problems at nursing homes have been building up for years. “No one who has been in this business is shocked by how things are,” she said. “The pandemic brought it to the fore.”

Porter, who has worked as a certified nursing assistant and as a nursing home administrator, said the industry should highlight how rewarding the job can be and how working as an assistant can lead to a higher-paying job, including as a registered nurse.

Care industry leaders say they have raised wages for frontline workers, but they can’t always keep up with other industries. They say that’s largely because they rely on payments from Medicaid, the government program for low-income Americans that covers utility bills. more than 60% of people living in nursing homes.

In recent years, most states have increased how much their Medicaid programs pay nursing homes, but those rates are still less than what facilities receive from other insurers or from self-paying residents. In Iowa, Medicaid pays nursing homes about $215 a day per resident, according to the Iowa Health Care Association. That compares with about $253 a day for people who pay their own costs. When nursing homes provide short-term rehabilitation to Medicare patients, they receive about $450 per day. However, that federal program does not cover long-term care.

Willett said a recent survey found that 72% of Iowa’s remaining nursing homes were freezing or capping admissions below capacity.

Prairie View Nursing Home in Sanborn, Iowa, is one of them. The facility, owned by a local nonprofit organization, is licensed for up to 73 beds. Lately, it has only been able to serve about 48 residents, administrator Wendy Nelson said.

“We could accept more patients, but we couldn’t give them the care they deserve,” he said.

Prairie View’s painful choices have included the closure of a 16-bed dementia care unit last year.

Nelson has worked in the industry for 22 years, including 17 at Prairie View. It has never been easy to keep nursing facilities fully staffed, she said. But the covid pandemic added stress, danger and discomfort.

“Drain the crap out of some people. They just said, ‘I’m done with this,’” she said.

Prairie View has repeatedly raised pay, with certified nursing assistants now starting at $21 an hour and registered nurses at $40 an hour, Nelson said. But she is still looking for more workers.

She realizes that other rural employers are also under pressure.

“I know that we are all struggling,” Nelson said. “Dairy Queen is also struggling, but Dairy Queen can change her schedule. We can not.

David Grabowski, a professor of health care policy at Harvard Medical School, said some of the closed care centers had poor safety records. Those closures may not seem like a tragedy, especially in metropolitan areas with many other options, he said.

“We could say, ‘Maybe that’s the way the market works, the way a bad restaurant or a bad hotel is going out of business,’” he said. But in rural areas, the closure of even a low-quality care center can leave a void that is difficult to fill.

For many families, the preferred alternative would be home care, but there is also a shortage of workers to provide those services, he said.

The result can be extended hospital stays for patients who could be cared for in a facility or by home health aides, if those services were available.

Rachel Olson, a social worker at Pocahontas Community Hospital in northwestern Iowa, said some patients wait a month or more at her hospital as she tries to find a place for them in a nursing home once they are stable enough to be transferred. .

He said it’s particularly difficult to track down certain types of patients, such as those who need extra care because they have dementia or need intravenous antibiotics.

Olson begins calling nursing homes close to the patient’s home, then tries others farther away. He has had to locate some people as far as 60 miles from his hometowns. She said that the families would prefer that she find something closer. “But when I can’t, I can’t, you know? My hands are tied.»