HERMANTOWN — The biggest problem the caregiving industry faces is short-staffing. Nearly all problems areas that administrators and providers shared with state Rep. Natalie Zeleznikar, R-Fredenberg Township, during recent roundtable discussions boiled down to a lack of people in the workforce to take care of the aging population.
Zeleznikar, who represents District 3B, serves on the Children and Families Finance and Policy, Human Services Finance, and Workforce Development Finance and Policy committees. She hosted two discussion events with providers this month: one at Waterview Shores in Two Harbors and one at Edgewood Vista in Hermantown. About 30 leaders at area nursing homes, assisted living facilities, group homes and home care providers attended the roundtable in Hermantown on Feb. 17.
“There’s too many people that are running the government in policy areas that have never done your work, and that’s dangerous,” said Zeleznikar, who has 40 years of caregiving experience as both a nursing aide and an administrator. “We have some Band-Aid things that are probably going to happen this session, and then we’ve got to get to work on some real issues. So I want to look at some ideas for solutions with you, not just the problem.”
Zeleznikar left the caregiving industry about a year ago, and told meeting attendees she wants to help the industry and would take their feedback with her as she returned to the legislative session.
“To date, in the first seven weeks of the Legislature, we’ve been talking about legalizing pot, we’ve been talking about a million topics, but we have yet to talk about how group homes, nursing homes and assisted living is imploding,” Zeleznikar said.
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As the population ages, the Duluth area is expected to see a 43% increase of older adults by 2030, many of whom will need caregiving services in one form or another, according to data from Home Instead, a home care service with franchise branches in Proctor and Hibbing. However, many of the existing care facilities and providers are struggling financially as they attempt to recover from the coronavirus pandemic.
Zeleznikar said she's frustrated in current state policy, which is punitive toward care facilities. She said fining facilities for incidents that don't harm patients, like delayed paperwork, just sets facilities back further. She believes fining facilities for some offenses just adds stress to care centers by taking time and money from struggling entities. Numerous studies on nursing burnout have shown working long hours and taking on more job responsibility while understaffed can lead to higher rates of negligence and patient abuse.
“The sense I heard from everybody is we’re over-mandated, we’re over-regulated, we’re penalized with significant fines at a time when, at no fault of their own, the whole world has been tipped upside down. I don't feel like it’s the right time to have a heavy hand,” Zeleznikar said. “We’re not going to accomplish anything if there’s no providers left in the community. So the goal to prevent abuse and neglect and not have negative outcomes — which is the intent of policy written — will not be obtained if we don’t have providers in our community.”
Carla Henning, founder of 4U Home Health Care in Hermantown, said employee paychecks are already taking the majority of the company's money, making it difficult to pay for behind-the-scenes costs. She thanked Zeleznikar for hosting the meeting with the community's caregiving leaders, because she believes the industry is often overlooked by the government when they create policies.
"When we got your letter, we were very excited to know that somebody’s paying attention to us," Henning said. "Too many times we’ve been in those situations, and I know money’s not everything, but the fiscal side does make a difference not only to our people but to our company being able to survive.”
Instead of fines, Zeleznikar said recruiting and retaining more staff to prevent instances of burnout in the future would be more helpful, and she plans to look into the strategies used when fines are issued.
She's signed on as co-author of a House bill that would give high school students credits for working in health care-related fields. HF613 proposes 11th and 12th grade students could earn one elective credit for 350 hours worked at an institutional long-term care provider or a home and community-based long-term services and supports provider, with up to two credits to be earned.
"Right now, College in the Classroom is something you’ve all heard of and there’s a lot of kids that have one year done for their four-year degree," Zeleznikar said. "I’d like the same thing available for the trades, for the one-year degree, for the tech college or CNA coursework in the classroom.”
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She also is in talks with the Minnesota Department of Health and the Department of Human Services to see if OSHA rules prohibiting teenagers under age 18 from using lift-assist machinery could be changed to a skills-based test to let younger CNAs do more with patients. She said the state of the workforce has changed, and she wants to introduce more entry-level workers, like high school students or recent graduates, to the caregiving field.
Mary Andrews, owner of the Duluth-area Home Instead franchise, said students and recent retirees make up a large population of her home care employees. The staff do not provide medical care to clients, but offer assistance around the house, some transportation to appointments and medication reminders, as well as companionship to clients at home.
“It's a terrific introduction for the pre-med programs at UMD, the nursing programs at St. Scholastica, as well as LSC, and then social work, too — the gerontology programs that they have at both universities," Andrews said of the home caregiver experience. "So we get those students in through the door. And it gives them some more practical, hands-on experience for patient interaction experiences, even though we call them clients. They’re not technically patients. “
To find meaningful work, something that really gives back to you, it’s that appreciation and a sense of what they're doing is making a difference in a person's life. … It's a very rewarding thing that we do.
Like the other branches of caregiving services, Andrews said she noticed the workforce dwindling before the pandemic, and has watched the labor market continue to struggle since then. And while she acknowledges that the industry is not for everyone, many people find a passion and connection with the clients they care for.
"To find meaningful work, something that really gives back to you, it’s that appreciation and a sense of what they're doing is making a difference in a person's life. … It's a very rewarding thing that we do," Andrews said.
Jon Nelson, executive director of Residential Services Inc. group homes in Duluth, said he supports a bill Zeleznikar has signed onto that would provide a $4 million public service campaign promoting the caregiving industry and its jobs for recruitment and community awareness. HF 813 would also use $43 million from the general fund to create grants for home and community-based care providers and incentives for eligible workers.
“I know we’ve all got bills, and we’re all looking for funding, and hopefully we’re not pitting ourselves against each other — we all need it — but this is something that everybody would agree is worthwhile,” Nelson said.
If I am looking for a job, am I going to wait two weeks before I make a decision? … Now it’s instant. McDonald's does interviews on the spot — hired. They don’t want to wait to do these things.
Several attendees said background checks, including fingerprinting, are slowing down the hiring process. Employers have faced monthslong waits for results on background screenings, at which point many employees no longer want the job.
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“We’re really asking people that we’re hiring to be food service workers, janitors, aides — any of these positions — to take all these steps before we can even do new hire paperwork?" Zeleznikar said. "If I am looking for a job, am I going to wait two weeks before I make a decision? … Now it’s instant. McDonald's does interviews on the spot — hired. They don’t want to wait to do these things.”
She also noted that many other area employers, including fast-food restaurants and gas stations, pay higher base wages.
As a matter of fact, most of the staff that have good backgrounds don’t stick around. Background checks are kind of moot. They don’t really do anything for us.
Toni Martindale, program director at Bluewater Residential Services in Duluth, said she lost a star employee over an offense from more than 30 years ago. She said in her experience, people's criminal histories have not correlated to their work ethic.
“Even doing the background checks doesn’t mean they’re going to be a good employee," Martindale said. "As a matter of fact, most of the staff that have good backgrounds don’t stick around. Background checks are kind of moot. They don’t really do anything for us.”
Several other topics of discussion at the Edgewood Vista meeting included the use of technology for patient monitoring, a potential change in the amount of training hours required for CNA certification and the lack of specialized care available for patients with unique needs. According to the Minnesota Hospital Association, the lack of available facilities cost hospitals $37 million in the week of Dec. 11-17.
"MHA found that in one week in December 2022, nearly 2,000 patients were eligible for transfer to a continuing-care setting such as a nursing home, group home, or residential mental health treatment facility but could not be discharged from inpatient care due to a lack of capacity in post-acute care settings," the results of the study read.
Zeleznikar said the meetings in Hermantown and Two Harbors were productive and wide-ranging, and that the issues discussed there are in no way unique to the area.
“That’s not something we’re going to fix right now, but we have to start having the conversations because it's not going to change for all of our worlds until we add it to the discussion,” Zeleznikar said.
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This story was updated Feb. 24 at 2:40 p.m. to clarify that Zeleznikar is no longer working in the caregiving industry. The story was initially published Feb. 23 at 6 a.m.
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