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SDAHO Roundtable Discussion with CMS Sparks Emotional Testimony from Nursing Home Administrators

​SDAHO hosted a roundtable discussion between several long-term care (LTC) administrator members and the Centers for Medicare & Medicaid Services (CMS) and the National Survey Team, on October 20, 2021. The meeting was arranged to allow members of the CMS team to hear firsthand the challenges that many of our LTC facilities are dealing with daily. Thirty-three member facilities were represented in the roundtable call, with several participants able to share their experiences over the past 19 months.

Whitney Podzimek, the administrator with the Evangelical Lutheran Good Samaritan Society, in Wagner South Dakota participated in the roundtable, sharing comments on the emotional toll today’s healthcare environment in nursing homes is having on her staff. “The desire to serve is depleting and we can feel it with all our staff. The staff that are left are going to break. I have struggled with my own mental health, there is a guilt that we are trying to take care of others but we need to also take care ourselves but there is no time to get away for our own doctor’s appointment or other things.” Whitney told CMS staff that a good day is measured on how much she and her team have cried. In the 1990’s there was a movement to change the culture of nursing homes from cold unwelcoming facilities to warm home-like environments, Whitney says the past several months have negatively impacted that movement. “I feel like the home-life environment has been stripped and we’ve worked so hard to change that culture to feel more like home. The past year has been mentally taxing for everyone.”

Tammy Hatting, COO of SDAHO helped facilitate the roundtable discussion and says she is so proud of those who spoke up during the call to share their stories. “Whitney Podzimek, of the Good Samaritan Society did such a good job at sharing her experiences, even though it was hard for her. Whitney summed everything up for us and her emotions hit home for everyone.” Tammy Hatting, COO SDAHO

Carmen Weber, CEO/Administrator with Avera Eureka Health Care Center in Eureka says personal protective equipment (PPE) fatigue is real, with staff quitting due to the stress. “We’ve had staff quit; particularly certified nursing assistants (CNA’s) due to PPE fatigue.” Carmen’s facility is owned by Avera, and she stated they do a good job at keep salaries up and assist with recruitment and retaining staff, but it’s not about the money anymore. “It’s not about the money, our staff is burnt out. We are really short of CNA’s; we do have traveler workers but the money we pay for them is not sustainable.” Carmen’s facility is down 6 beds, and she says they will not be taking anymore admissions, in fact they are looking at cutting beds because they don’t have the staff to care for the residents with no applicants for the open positions. “We don’t have any applicants because we are a very rural facility. With no applicants on the horizon, we may need to cut more beds and other facilities around us are having the same issues. With the PPE requirements and vaccination mandates coming down, that is 2 or 3 people we can’t afford to lose, it’s tough out here. We have 4 people waiting to get into the nursing home and I don’t know where they are going to go.”

Many of the stories shared by SDAHO LTC administrator members focused on workforce shortages and the challenges brought on by COVID-19 that included increased regulations and unfunded mandates. Kristi Livermont, the Administrator for Avera Gettysburg Hospital and Avera Oahe Manor Long-term Care facility, says her struggles are the same as many of her fellow administrators living in a very rural area, even finding traveling nurses has been a challenge. “We have four full time CNA positions open and no applicants. Traveling applicants are far and few between as well, because a lot of those folks don’t want to come here. Our LPN’s and RN’s are picking up those CNA shifts and that is getting frustrating for them.” During the roundtable discussion, Kristi shared with the CMS staff that it’s been difficult for the leadership team knowing where to focus priorities. “Should our priority be for the quality of life and resident rights or is it infection control practices, we struggle everyday with making this decision.” Like many healthcare professions across the country, Kristi’s team is asked to wear a lot of hats which can be stressful. “For example, our activity staff that consists of two people help with developing and creating the activities, but they are also asked to help feed the residents, they are asked to help with transportation of residents to appointments, sometimes 60 miles or more away. The same two people are asked to help with resident visits which include in-person or virtually, it’s a lot.” Kristi says this past year was really hard for the limited staff being asked to do so much. Even more difficult, the facility recieved a deficiency for not providing enough one-on-one time for the residents. “We can only do so much, is it quality of life and resident rights or infection prevention and control, we don’t know where to focus our priorities.” Kristi Livermont, Administrator for Avera Gettysburg Hospital and Avera Oahe Manor Long-term Care facility

The mission of the roundtable call was to provide insight on the issues nursing homes are facing in South Dakota. In addition to addressing the challenges, the roundtable included time for a conversation about solutions moving forward. “I am so grateful for all of the nursing home administrators who joined and spoke up to share their stories and tell the truth. Whatever decisions are made by CMS moving forward to assist with these challenges, they will never forget the caring, compassionate and amazing administrators we have here in South Dakota and what they are doing for the residents.”  Tammy Hatting, COO SDAHO

Participants of the Roundtable discussion shared their appreciation for having the opportunity to speak directly to CMS representatives. Richard Kyle the Executive Director of the Rapid City Area, Evangelical Lutheran Good Samaritan Society applauded the SDAHO team for facilitating the session in addition to the SD Dept. of Health. “Thank you so much, I appreciate everyone for coming together and having this session. We know we all have jobs to do, and we appreciate you coming to help us find areas for improvement and work on those areas.  If we are not improving, we are not doing our jobs of making our facilities, not a facility but a home for our residents and a great safe place for our staff to work.” Richard Kyle, FACHE, CPHQ Executive Dir. Rapid City Area Evangelical Lutheran Good Samaritan Society

Will Harris, Senior Advisor, Office of the Administrator with CMS shared his appreciation to those taking part in the roundtable discussion, calling the work they do heroic. Harris also told participants it’s important for he and members of his team to hear from those who work on the frontline, and the work they do is important.

To connect with the CMS Denver Regional Office, please contact:

John Hannigan, Regional Administrator, John.Hannigan@cms.hhs.gov

Jeannie Wilkerson, Rural Health Coordinator, Jeannie.Wilkerson@cms.hhs.gov

General Inquiries for Denver Office, Rodenora@cms.hhs.gov

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