The announced closing of more Nebraska nursing homes simply adds to the struggle small rural communities are facing. Not only does it remove a care option for loved ones, it also removes an employment opportunity for people struggling to find non-agricultural work.

There are no easy solutions, but the situation does call for a statewide, if not national, discussion.

The Nebraska Health Care Association says the latest closures are located in Columbus, Blue Hill, Milford and Utica. The association says the homes employ a total of 240 workers and have 205 state-licensed beds. Closing the four allows the company that acquired them and others to keep the others open and operating successfully.

A company spokeswoman said Nebraska’s fiscal landscape doesn’t make it viable for many long-term care facilities to continue providing the high-quality care residents deserve. Most nursing homes provide care to residents who receive Medicaid — a program that helps seniors who meet certain income criteria to receive the care they need.

However, the state of Nebraska does not pay nursing homes a rate that covers the cost of providing care to residents. They continue to reduce payments that are necessary to provide crucial care to one of the state’s most vulnerable populations, the elderly. During the past two years Medicaid rates have been reduced by as much as 7.17 percent.

Nebraska Health Care Association CEO Heath Boddy said two main factors contribute to the closings: difficulty finding workers to keep the facilities fully staffed and operating losses because of low Medicaid reimbursement rates. He said the Medicaid reimbursement rate per patient on average is about $36 per day less than the facilities’ costs.

Ron Ross, president of Rural Health Development, a nursing home management company, said nursing homes have limited options to make up the shortfall. Statewide, 53 percent of nursing home residents rely on Medicaid to pay for their care. In rural homes, Medicaid pays for as many as 65 percent of the residents, he said.

Ross agreed that the industry is in a slump. Vacancy rates have grown as the number of alternatives has increased and state and federal programs encourage more use of less costly home- and community-based services. But an increasing population of seniors likely will increase the need for nursing facility care.

If nothing is done, long-term care options will disappear in parts of the state and displace more residents, moving them away from their families and communities. That gives new meaning to “over the river and through the woods” to visit grandma.

State Sen. John Stinner of Gering, the Legislature’s Appropriations Committee chairman, said he is concerned about the trends, especially how they are affecting rural nursing homes. When homes close, he said, it can mean rural residents have less access to care nearby. A Stinner bill, incorporated into the main budget bill passed last session, would prohibit the state Department of Health and Human Services from including application of the inflation factor when calculating Medicaid nursing facility rates beginning in fiscal year 2019-20.

Stinner said 16 nursing facilities closed in Nebraska between 2015 and 2018, and 22 have been placed under state receivership — the majority of them located in rural areas. “It’s not a sustainable business model when a nursing facility is paid less than its costs to provide care,” he said.

Boddy agreed, saying the time is now to find something sustainable to avoid big-time gaps in health care.

Add this to an already overflowing plate for the upcoming Legislature, but give it the priority that Nebraska’s aging population and small town survival deserves.

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