(00:00:00) NPR's Main Street radio coverage of rural issues is supported by the blandin foundation committed to strengthening communities through grant-making leadership training and convening. Good morning and welcome to a special Main Street radio broadcast from Rochester. I'm Rachel re be our to our program today will focus on senior citizens and Minnesota's long-term care system will look at what options are available for the elderly and how we're preparing for the coming wave of Aging Baby Boomers, but first, let's talk about the current challenges facing the state's nursing homes Our Guest this morning at the Minnesota Public Radio Studios of k z SE que él se in Rochester are dr. Kevin Fleming Mayo Clinic geriatrician and Markus Persson executive director of Samaritan Bethany Inc, Rochester nonprofit corporation. Operates for nursing homes, Senator. Sheila cascading is joining us from our studio in Saint Paul. She's a Rochester Republican who serves on the Senate's Health Services committee. Good morning and welcome to all of you the morning. Our phone lines are open for your questions and comments this morning. You can call us at one eight hundred five hundred 75252. The number again is 1-800-585-9396 economy means that almost anyone who wants a job can have one but that's what tremendous pressure on some employers who can't find enough workers to fill positions. It's especially true in the healthcare field where there is a Statewide shortage of nursing assistants. The problem is most acute in Southeastern Minnesota 60% of the nursing home surveyed in this region of the state say they have closed beds or limited admissions because of lack of Staff. The biggest need is for nursing assistants almost 90% of the nursing homes in Serie need nursing assistants, let's start out our conversation there. Dr. Fleming from your perspective what's going on? Why can't nursing homes find nursing assistants? (00:02:12) The major problem is that the local labor market has been so tight we're competing for workers with McDonald's with hotel workers with the same level of workers are demanded across several different kinds of Industries. The nursing homes have been struggling with poor pain benefits. They've been struggling with the very understaffing itself makes people not want to work there. That is the job is harder. It's a demanding job to begin with its physical labor. That is tough. When you ask the people that stay they love doing what they're doing, but it is hard work and there are several problems including Healthcare benefits low wages that Have made this problem worse overall the reasons it's a crisis now has partly to do with the labor market, but partly to do with what had happened at the same time a real change in the way nursing homes are paid and how much they're paid for taking care of people and it's made it impossible to pay these workers more. (00:03:21) Mr. Cass person could just see this coming on the horizon (00:03:25) really the subject of the storages and the challenges associated with that have been the subject of discussions as early as five years ago, perhaps even longer than that. We had a project mm undertaken by our Statewide Association, which really five years ago started talking about the sorts of things that needed to be considered and of course at that time that didn't even take into account the unparalleled. Old economic upturn that has occurred particularly over the last three years. So we really were beginning to see the tip of the iceberg in the summer of 96 as the economic growth engine of not only this area but nationally really started to impact our interest industry in a very very significant way and that has only become more acute really from that time (00:04:29) Senator kiss Caden you represent this part of the state Southeastern Minnesota. Why is it so much worse here? Well, we are very fortunate in many ways in our part of the state because our economy is so very strong. And that's a big part of it. We have overall. I think our unemployment rate in the Olmsted county. Is that 1% And the Southeast region generally is part of the sort of the Fertile Crescent of economic Vitality of the state of Minnesota, but beyond that we also have some very unique characteristics of our When you consider that we have the one of the more major medical institutions in the world in our in Olmsted County with the Mayo Clinic and the need to discharge a lot of patients into nursing home care. Now, you know starting in the 80s the federal government changed the way that they compensate hospitals that creates incentives for hospitals to discharge patients as soon as possible and then that increases demand for skilled nursing care for rehabilitative care and convalescent care short-term stays which then of course increases the demand for nursing home bed space in our part of the state we could add one other factor to that and that's the state of Minnesota because we have more beds than most has had a moratorium on building new nursing home beds. And so even though there's greater demand in Southeastern Minnesota for nursing home beds. At least we believe there is we haven't been able to increase the number of beds available. But of course since there's a worker shortage now, that's somewhat move. It wouldn't have done any good. Well phone number is 1-800-543-8242. We have Kate from st. Paul on the phone with us. Good morning (00:06:11) Kate. Hi, this is Kate. (00:06:15) Yes, go ahead with your question, (00:06:16) please. I just have a comment. I worked in a nursing home for a year and a half and it was a very frustrating and difficult experience. I work in a hospital now and I can't believe the difference. I mean the paperwork that we had to do with the nursing home was just it prevented any meaningful contact with the residence and I just think that there needs to be less micromanaging of the staff are I mean the side rails for example, excuse me. It's a well-meaning idea. But the reality of what that was like in the nursing home was I mean it was just horrible the families were upset and the staff had a hard time with it. It was I mean, I think that there needs to be different management of the system, (00:07:03) you know, you've hit on a very strong point here and that's the amount of paperwork the regulatory oversight in the nursing homes is so big that Right. Now that's actually increased in the last few months to the point that a new patient in a nursing home requires at five Ed admission at five days at 10 days a five-hour paperwork burden five hours that's directed at sitting in front of a computer typing in data. That's not giving care and people who do that people do this job want to care for people but what they don't want to do is fill out paperwork. It is in fact micromanagement. (00:07:46) Thank you for your call. Kate we go now to Laurel Laura we have you on the phone with us. Good morning. (00:07:54) Mark test persons mentioned that there was a group that had looked at the labor force issue earlier and actually the the I'm on the staff of that group the Minnesota Health and housing Alliance and we represent about 600 long-term care providers both housing and nursing homes and the state and about nine months ago. We started and in much more depth exploring the labor force issues and I'm hearing a lot of you know, a lot of the same issues are coming up in terms of the increased demands on the on the staff particularly on the nursing assistants. There's a lot of I think a lot of us are on the on the same song sheet now in terms of defining the problem and one of the things that the Blue Ribbon Commission on labor force issues that we have going is to start looking at possible solutions. I wanted to share a couple of things that we've that we've sort of defined. Although we haven't come come up with something definitive yet. And one is that whole issue of being more competitive with other employers. It's a physically and emotionally difficult job and we pay on average less than nine dollars an hour, which is more than a dollar short of the living wage and Minnesota. So wage increases are obviously part of it employee benefits, you know Health Care Child Care Transportation are and also one of the things that Senator Cascade and has has promoted as this opportunities for advancement within within the career, but there's also this other issue which is that the pool of traditional nursing home workers and the community is shrinking because of demographics. Females in that age Court cohort between 20 and 30 are shrinking or in rural areas or migrating out. And so two of the things that we're really trying to get our arms around is working smarter with your existing workers, avoiding sort of duplicative efforts and allowing caregivers to spend time giving care instead of filling out paperwork with both Kate. And dr. Fleming mentioned the other piece which has been kind of interesting and is really sort of thinking outside the box is this whole idea of growing the existing pool of workers sort of looking outside the traditional Workforce and here one of the strategies sort of desperate desperate problems require desperate Solutions is a actually looking outside the United States and trying to see where where the foreign-born workforce might be able to supplement what we've got here in Minnesota. We've got a number of people working on bringing Nurses from the Philippines and recruiting nurses from Canada to come down and work here because we have sort of the unfortunate situation of having a very strong economy in Minnesota and it's not so strong elsewhere. So the United States is a popular destination. So this (00:11:00) in Turkish Caden, let's have you address. Let's start with the second question first bringing in the workers and I understand some of the materials I've read two hundred thousand unemployed workers in the Philippines, who would love to come and have these jobs. What's the problem in doing that? Well, there's a we did pass some legislation this year that would allow workers to take a competency test to demonstrate their skills rather than have to go through defined training programs right now to be a new worker. You have to go through a 90 our training course of a certain certain specification by the health department. So that's one thing we've done to try and facilitate this idea of bringing workers from other countries, who are Qualified to do the work one of the issues. However is language differences and cultural differences in working with an elderly population where communication about the patient's needs is very important to be able to adequately provide for the care of the patient and I've observed this myself because we've had a number of elderly relatives in the same nursing home and they've all died in the last few years, but in in Bloomington and what I observed in the five years that we had family members there is that the entry-level Workforce changed and in that particular nursing home. They have many African immigrants working in but they were English speaking African immigrants, but there still were notable cultural differences. So that will be a challenge. If this is part of the solution that will that will post some different kinds of challenges racial differences cultural differences language differences and you note that in the nursing homes. They tend to be white people and there aren't many people of color in nursing. Arms, so so you have we have some other subsets of the problems of Are We serving the minority population very well in the state of Minnesota. That's another kind of (00:12:52) question. There's an additional Dynamic here, which is a significant one in terms of persons who might in migrate and what wages would be available to be paid to those persons and how they would be able to sustain themselves and in local settings in respect to other housing needs and and other personal and family needs that are certainly at a level that that require a level of compensation for those workers amongst the workers who are native born in here. Now that make it very difficult for people to meet their personal needs and secure housing if it is even available, which is an additional a complicating Factor here in our (00:13:38) region and let's go back to the first question, which is if you can't find workers. I can't you just raise the wages until you get the workers in. It's not that easy in your industry. Isn't mr. Cass person. (00:13:50) Well, it certainly is not and we are unlike even the states that are on our borders and respect to how our reimbursement structure works. We are in the the process of re-evaluating really by way of current legislation and perhaps the senator can comment on that but really converting from what has been for years referred to as a rule 50 reimbursement structure to an alternative payment system, which gives some more flexibility on the part of the reimbursement structure, which is either the state or the federal government and individual providers. And we need that kind of flexibility. We effectively are operating within a structure that demands more and more and more of us and provides us less and less and less in terms of resources of being able to deliver on those requirements. (00:14:43) If I could Senator, yes, go ahead. It was just really skew significant thing is that the state sets the rates in effect for all of the nursing homes, whether your private pay patient or whether you're there with public assistance. In fact about two-thirds of the patients who are in nursing homes are there in public assistance? So we get a couple of other interesting Dynamics going on one is we set the rates and we've written the last several years been trying to Target cost of living increases directly to the wages for the entry-level workers. But right now we're proposing a 3% and 4% cost of living increase for nursing homes and other kinds of health care workers at these entry-level and it costs the state over a hundred million dollars and it translates to about 14 cents an hour for the worker. So it's a very significant problem another Dynamic we have going on however in dealing with the elderly is that we have a New Concept called assisted living and in Rochester, there are many new programs being built and around the state knew. Facilities being built that are assisted living facilities and they're generally apartments and then you get care in your home or in your apartment. When you start to need the assistance with your daily activities or you need medical care. Well, what we're finding is that those in those facilities are really not regulated At All by the state the way skilled nursing facilities are and so people are are able to go into those facilities and pay out of pocket for those four for that kind of care and at the point then when they have exhausted all of their personal resources, they're ill enough to qualify for a skilled nursing facility and they go into school nurse Nursing Facility. So we're beginning to see develop a two-tier system where the nursing homes increasingly are caring for the very ill who are poor and people who have other kinds of resources are able to get Care at home either in an assisted living facility or through a Home Care Agency. And so it's a it's a Troublesome Trend and it's going to pose an interesting. Dilemma for us that then kind of aggravates the worker shortage problem because we actually have our larger variety of care situations Home Care assisted living and skilled nursing that aggravates the worker shortages. Well, we have Marge Inman on the phone with us Marge has a nursing assistant at the Stewartville Care Center a nursing home 10 miles south of Rochester. Good morning, Marge you've worked as a nursing assistant for 20 years. Tell us a little bit about what that job (00:17:13) entails. Well, my shift starts at 5:30 in the morning. And of course, what I need to do is to get the resonance up and ready for the day, you know, it involves dressing them doing their their teeth taking care of their there are grooming taking care of bathing if they're scheduled for a bath that that day cutting their fingernails cutting their toenails, totally eating them positioning them turning them when they're in bed helping them eat if they need to be fed, you know, it just entails a lot of different things (00:17:53) and what has the shortage of nursing assistants meant to you with that nursing home. (00:17:59) Well hits It's the stress level for anyone that has to work short is very high because that put you with a lot more patience to do per person and that they usually figure about ten patients per person and that leaves you doing about 20 then alone. If if you're short staff, (00:18:22) and I know that the turnover is very high for nursing assistants. Some people estimate it could be as high as 300 percent a year 100% at the low end. Why do you think people are coming in and then leaving so quickly? (00:18:38) Well the job market out there is huge right now. I mean that you can go anywhere and get a job and and this would be the last I would I think it's a last place people would apply for a job. It's not it's not the type of type of work people want to do anymore. The pay is poor. The benefits are getting cut all the time in nursing facilities because Nursing homes are being reimbursed enough money to carry a very good benefit program. And so they're looking for those actions are looking for benefits are looking for higher wages, and they're not they're not offering that in nursing homes. (00:19:19) And I think that goes to the central question here, which is how are we going to care for older people. The quality of care in nursing homes is going to be directly dependent on the quality of staff that are taken care of them. It's the same as in say daycare. And if we value the staff if we show them that we value them by their wages their benefits by how we treat them in management the kind of educational and benefits that they have in the and the kind of improvement in their work that they can get all those things. Say we value you because we value our older people exactly what I think this really says is we're not we don't really value older people for a lot of reasons and I'm sorry to actually say that because it comes down to to me that the Staffing shortage is a direct reflection of how much we care for people who are our parents our grandparents. Neighbors and (00:20:19) Friends Marge. Do you find that the people you work with the other nursing assistants? The reason they stay with the job is not because of the money or the working conditions, but because that it's a Ministry for them you feel that way. Is that why you stay (00:20:33) - yes, that's basically why I stay but it's getting to be too. It's getting to be hard to even stay because of the ministry part of it because there's so much other things going on within the each facility that tends to start to turn you away from what you really love to do. There's there's because of shortages the stress level is high for for everyone. I mean the nurses all in on the way down. So it makes it hard to work in that kind of environment as you could probably (00:21:12) understand Marge from your opinion. What are the solutions? (00:21:18) Oh my I wish I could answer that question. I think that I think the nursing and nursing assistants need to be treated like they're professional people for one thing by the community and society that this job is important. I know families are very good to us. They they they really praised us for what we do and that you know, that's wonderful for all of us, but You know, I just I can't answer the question. Totally. I know the money is an option benefits are an option. There's a lot of women that are working in this field that are that are single parents. They need they need those benefits. They need that money. They need to be able to raise their family to as well as be here to take care of these people because they love to do this job. (00:22:16) And one thing we've done to try to improve the image of nursing assistants. Is that our nursing home Consortium is sponsoring for the first time on nursing assistant educational conference, which is just for nursing assistants and it's coming up in May (00:22:32) so that might help with the morale issue. This being undervalued underappreciated ignored. (00:22:37) Yes, because the we recognize as they do that investing in their training shows that we value their work. I think an important Point here as well and regrettably these things often times boy. Down to a tool matter of money and we've heard Marge comment and Stewartville that clearly an increase in the wage structure is significant and she mentions benefits as well. And I think that's important in the current environment to pause on that point for a moment because in the current legislation as I understand it dollars being considered for purposes of enhancing wages seem to be making their way along but they are at a level that regrettably seems to to be very minimal in terms of the competitive environment, but not only that seem to be very much focused only in the wage area which is certainly important but seems to deny the fact that increasing benefit costs are also at work increasing fixed cost and facilities are also at work in a way that the dollars that that are forthcoming. Can't only be focused in the wage area and that is providers. We need to have the ability to to also see an increase on the inflationary cost of doing business as well. And so having increases in both areas are going to be absolutely essential to facilities throughout the state in order to really be competitive in this market and to provide quality (00:24:12) Care Marge Inman. Thank you for joining us today. We're talking about the labor shortage at Minnesota nursing homes with our guest Senator Sheila kiss Caden. Dr. Kevin Fleming and Mark Cass person. I'm Rachel riebe and you're listening to a special Main Street radio broadcast from Rochester. Mpr's Main Street radio coverage of rural issues is supported by the blandin foundation committed to strengthening communities through grant-making leadership training and convening. We'll be back with more of Main Street after a look at news and (00:24:42) weather coming soon a bigger better Prairie Home Companion spring Extravaganza, if you've always wanted to see the show live, this is your chance to join us. Saturday April 24th at Northrop Auditorium on the U of M campus for Garrison Keillor special guest who Bunny's bow the guys All-Star shubin and all the news from Lake Wobegon and much more for tickets call Ticketmaster and 6126730404. It's A Prairie Home Companion the spring Extravaganza, April 24th at Northrop Auditorium. (00:25:10) Good morning. It's 11:31 with news from Minnesota Public Radio. I'm Greta Cunningham NATO officials today refused to release further details or show pictures or video of this week's accidental attack on a refugee Convoy NATO admits it accidentally hit one side and Kosovo, but no one will discuss Serb TV footage showing bodies and wreckage in an area farther to the South you kasab officials are claiming 20 civilian casualties in the latest wave of NATO air strikes. There has been no independent confirmation of their claims Yugoslav news agency also says there was significant damage in civilian areas of a village in central Serbia and it says belgrade's main airport was targeted in the air strikes defense secretary William Phone says a significant number of reserves could be called to active duty in the Kosovo conflict Cohen did not give an exact figure on how many reservist will be needed. He says he doesn't expect a decision on that for a few more days Cohen also says NATO will continue to do everything possible to keep civilian casualties to a minimum but he adds such casualties will occur in the future just as they have in the past officials say as many as 500 people are homeless after wild fires burned almost 50 houses in Port st. Lucie Florida dozens of other homes were damaged and whole neighborhood's were left without power and water officials say the fire is contained but they're worried that stiff afternoon winds will bring new flare-ups. There are reports today that hockey great Wayne Gretzky is going to announce his retirement Gretzky is expected to make the announcement this afternoon in Regional news in Minnesota Public Radio. St. Paul Pioneer Press poll finds most minnesotans believe U of M men's basketball coach Clem Haskins should lose his job if allegations of cheating among his players or true 68% of the 628. People polled say Haskins should be forced out. If it's true several players had their course work done by others. The polls margin of error is plus or minus 4 percentage points looking at the weather for Minnesota. It will be blustery and cold today with the possibility of snow mixed with rain in western and southern Minnesota highs today ranging from 35 to 45 degrees at this hour Rochester reports cloudy skies and 39. It's clouding Duluth and 42 in the Twin Cities cloudy skies and 43. That's a look at the latest news. I'm Greta Cunningham. In the next 30 Years baby boomers will become senior Baby Boomers the over 65 population in Minnesota is expected to double what will our options be for long-term care. And how is the system getting ready for the Bulge? We'll be talking about that next hour but first, we're continuing our conversation about the challenges facing nursing homes today. Our guests are Markus Persson executive director of Samaritan Bethany Incorporated and Mayo Clinic geriatrician. Dr. Kevin Fleming there in Rochester with me at the Minnesota Public Radio Studios Center Sheila cascading a Rochester Republican who serves on the Senate's Health Services committee joins us from our studio in Saint Paul and our phone lines are open for your questions and comments. You can call us at one eight hundred five three 75252 we go now to LaPorte where a net is waiting on the phone. Good morning (00:28:13) Annette. Hello. I'm calling because I maybe have a little bit different perspective on all of this. I agree with all of the other. Dollars, but I worked at as a in a nursing home two years as well for 13 years at one particular nursing home. But at a couple other nursing homes as an aide and then as they say moved up into and work got my degree or my licenses and LPN and then continue to work for the for the 13 years as an LPN. And then since then I've gone on to school and have my 4 year degree in nursing. I think a good part of the problem comes in with way back on your program before this. I think his name was mr. Salamander or something like that. Anyway, he said they were talking about taxes and he said we reward success. We don't reward failure and I think that in a lot of cases and in the one caller also mentioned from the nurses all the way down and I think that people who stay as an aide feel strongly that Society we guards them as a failure I have It's a deliberate choice to stay in northern Minnesota to stay in a rural area and I work in nursing even though I know that if I moved to a bigger area, I would make a lot more money. I think we need to look at these people as real assets and and maybe it is a simple thing as of changing the track tax structure so that so that there is some benefit and staying at something that you love and that you are very successful at but yet not a failure in society. (00:29:56) So again, dr. Fleming it's going back to the morale (00:29:58) question it is and to be honest in our society to grow old and frail is a failure itself that we look at no longer being independent as failing as a human when in fact, that's not true. This happens to everybody. We all grow old the same way. It's particular to our culture that Independence is the god that we serve and that dependence is to be avoided at all cost when in fact not at not a hundred years ago. That wasn't the case people were allowed to become frail and older and stay at home and cared for and honored in in in there dying as they got older and I think we need to return to that kind of thinking we're caring for someone in dependency is something to be honored and how we get there is really something that the state needs to take on as a whole Senator cascading this year alone has championed a lot of these issues at the Senate level and we are actually working on a state level group to do exactly this to look at this question. How can we really show that we honor our older citizens by caring for them? Well, I think that's really a very very significant piece just by virtue of the title of human. Versus and those working staff who are so committed within our facilities throughout the state certainly don't consider themselves failures. I think that others from time to time through the years in other Industries, perhaps have have thought that but I know our dedicated professionals throughout our structure and I'm feeling throughout the state having just attended and February are our Statewide Institute went with a Minnesota Health and housing Alliance and the governor came and address for the first time this group of approximately 3,000 workers from throughout the state that group takes great pride in what they do and they are committed to that and they certainly don't feel like failures on a daily basis, but they do feel failed perhaps from the standpoint of what the system has been able to bring forward and support them with in respect to really Being valued and I think that's the important effort that we meet. We need to make (00:32:25) now Senator Cascadia. Isn't this also a question of the regulation when we talk about morale and we have a group of workers that are already overworked perhaps and certainly underpaid and then they have the added pressure of having somebody at their shoulder watching them writing them up. If it isn't done right? It's such a regulated industry. I know some of the people that I've spoke to us, that's why they can't take it anymore. The the fear of The Regulators coming in and writing them talk about feeling like a failure. Well, I think you heard in one of the preliminary comments. I think dr. Fleming said that it we're asking staff to spend five hours within within short time of emission three times just on paper documentation and we hear this consistently legislators here consistently and I've turned to dr. Fleming and mr. Cass person others and said give us some specific examples. I have tried in the past to read. Some of this regulatory requirement so that people that really are in the nursing homes who are the caregivers can give the care and not be spending their time at a desk and it's amazing to me. But what we have in place has a strong belief that with high levels of Regulation, we can assure quality of care. And in fact, we now know very clearly. In fact, it's getting in the way of quality of care of Hands-On care for patients. And so I think we need to have a really broad discussion about how do you do quality assurance in nursing homes? And in all kinds of care settings without having to document absolutely everything that's done and I've been on the losing end of proposals to deregulate certain things when The Advocates come forward and they're worried that without regulation people will be placed at risk and somehow it's an issue of trust as well. And we do have to acknowledge that people sometimes are hurt in a care setting and there are risks both in the care setting and at home, but once we're in a carousel We think that there should be no risks at all. So it's a very it's a very difficult question and we're looking for answers and we have a couple of work groups that are are looking at that whole question of how do you measure outcomes instead of just measuring what has been done on a daily basis, you know, the governor even address some of this and the example he used in happen to be an accurate one in the State of the State address, but he's right we measure what is done instead of what is the outcome of what's done and that creates a very negative environment for the Care staff and it takes the way the Care staff from giving the care that they really want to do to those individuals who need it. Let's go back to the phone. We have lots of caller standing by we go now to Eden Prairie. Good morning, (00:35:08) Chris. Are you there? Yes, I am. Okay one thing is anyway that appreciates this discourse on the radio want to be a public radio member and contributing. My point is this nursing assistants like school bus drivers for instance are the workers that are behind the scenes that are the unappreciated ones. The only way to fix the nursing assistant employment crisis same way. We fix the school bus driver crisis because there's not enough of them either is to get those people into unions get them get their unions working for them to raise their pride and of course to raise their, you know, wages and terms and conditions of employment and I think employers and the government need to start seeing unions as partners in raising that pride and Consciousness and respect of those what are considered the lower end workers, and I know that local Authority for local 113 or unions that are standing ready to do that kind of thing, but we run into a lot Problems with management who see the Union's is, you know, some kind of an adversary when in fact, they should be seeing him as a partner. So I think we should look at getting lower wage earners into unions and working together as a partnership and I'll take your comments off the air. Thank you very much. (00:36:18) Thank you for calling Chris. Let's address this in. Mr. Cass person. Maybe you could begin. Would that work? Would that solve the problem or if there is this much money to divide up among this many people does it not matter if they're unionized or (00:36:33) not? Well, the question of Union participation of course is is probably a very complex one because it is perhaps in many cases facility-specific and we have the partnership kind of approach that the gentleman speaks to at work in several of the facilities throughout the state and that has been very productive and and contributes to a positive environment on the other hand. It has presented challenges if not problematic situations where there are these limited resources and that perhaps there are very high expectations that come with the Union organizing that purely are unreachable and unbeatable in terms of the resources that are available. So sometimes it heightens expectations that that are unrealistic and can't be met within the structure. So it is perhaps Facility-specific if not a regional question and one that isn't universally (00:37:41) applicable Senator cascading. How would you respond to that? I think definitely we're seeing a trend across the state. In fact, the caller is obviously was an advocacy call in many ways. But we are seeing Trend across the state for for workers of joining unions and Union seeking to get to get Workers to join and I think that that in part is a reflection of whatever their workers who are dissatisfied then that becomes very appealing to them and I think that that is that's a trend receipt. (00:38:15) And I think it really goes back to the original problem, which is that we're looking at the fact that we're going to need 45 or 50 percent more of these same kind of workers within the next 10 years how we're going to get there. I'd love to be able to blame somebody to say, you know, what there's this group or person or rule or regulation that is at fault. But in fact, there isn't any this is so complicated and yet if you go back its kind of simple. We are called to take care of people as they grow older as they grow older and and these people are important to us how we're going to do it with the limited resources needs to be discussed openly and at length and and whether this is done at a county level at a state level we have to have some of the power to be able to decide how we spend the little money that we do have maybe we decide to spend some more but we have to have some control over just how we take care of mom and dad and grandma and grandpa and do we have to spend our money on computers or can I spend it on actually bathing them (00:39:29) we've talked about how nursing homes have been affected by the labor shortage Turning Away business and idling beds has caused a financial crunch for the homes, but it's also caused major problems for families trying to place somebody in a nursing home. We have Janet pins with us on the phone this morning from Rochester. Good morning, (00:39:47) Janet. Yes, how are you, right. (00:39:51) I'm fine. (00:39:52) Yes. I've been listening to the radio. I'm very impressed. Why what's been going on and IQ I sort of have the same ideas as they do too. (00:40:02) Let's talk about your specific situation Janet when you're 90 year old mother needed to move into a nursing home last September how difficult was it to find a place for her to go? (00:40:13) Well in our case Chief we chose to stay home. And so we made bread in her cookies and her cakes and we brought her groceries and everything and she was just well to be able to take care of herself pretty well until she fell last August and then we took her to the hospital and because I just couldn't lift her and get her to the bathroom and she was 90 and and that end, I think I told you the other day that it was probably a week that she was in but I think she was in over two weeks. Before we were able to get her any place into a nursing home. And then we had to choose one. It was in the area. We couldn't choose one that was right in Rochester. And and the first one that came about what's been Plain View and so she went out there eventually. They said we could take her back. There was a place back in Rochester, but she liked it out there. It's very nice and she chooses to be out there (00:41:26) but it sounds like though is it's a half an hour from your home. It's a long distance phone call and you have a nursing home down the street that you could walk (00:41:35) to that's right and and I don't drive which is causing a problem. But we do get out. I get out a couple times a week and my brothers get out there to see her and We do go out there. We do spend like a couple hours with her and and she seems quite content living alone isn't the best either, you (00:42:01) know, well the just brings up a very important problem in that I myself have had to tell spouses that their family member their spouse is going to go out of town to a nursing home and they couldn't drive and and we sent them away in tears and there were no options there. Yeah. So in in Rochester, it's reach that kind of Crisis where we're separating families from each other at the very time. They need people the (00:42:28) most that's right. (00:42:30) And it's one thing if the eight nursing homes in Olmsted County were filled to the brim. All the beds were filled. I think that would be easier to take but knowing for instance at your facilities 15% of the beds are empty that has got to be a painful reality for people who so desperately want their family. Close to home as everybody. Yeah, that's true. That's (00:42:54) true because I wouldn't only had a couple blocks to walk and I probably could have gotten down there most every day, you know, just to just to see her and talk to her and everything so it would have been better but I don't know part (00:43:08) of the ethical dilemma that's actually presented to facilities when this question arises and that as our social services staff receive calls referrals from the the hospital environment and we are faced with having to make difficult decisions based upon the Acuity of care needs of the person who is potentially an admission of whether our staffing will allow us to meet those care needs and you when you have perhaps competing family requirements before you on the table Imagine The Dilemma that that place is the facility the social worker and when when you're dealing with critical issues that affect families so deeply in This way having to try and respond to that and frequently not being able to do so in a positive way and not being able to recognize that older people are not objects and can't simply be placed wherever there's a space that's open. There's another Dilemma to family members. (00:44:08) The other dilemma is that there are many people who are at home who would like to stay at home, but they can't even find any assistance is the same kind of worker shortage for to be a personal care attendant or to work in a Home Care Agency to provide care in their home. So we're stressing today the shortage in nursing homes, but this there's parallel shortages of this of these caregivers staff in a variety of settings. And you know, it's I hear from constituents who are at home. Sometimes quite disabled reliant on having rely on having a personal care attendant and they can't even find them anymore. (00:44:46) That's right. We looked into that too, and there just wasn't Way and mother is the type of person she slipped my father passed away in 71. He's lived alone for 27 years in it's not easy for an elderly person to accept another person in your home. You know, who is he instruct you (00:45:04) so much for joining us and for sharing your story with us this morning. We are going to continue to try to answer some of the phone callers that we have waiting on the line for us. We're going now to Janice in st. Paul. Good morning, Janice. Janice were waiting for you. You can go ahead with your question or (00:45:23) comment. Okay, I think probably I'm one of those people who is helping to create a shortage of Staff workers. I worked for several years as an employment counselor and nurse's aide is just one of several positions that I will counsel people to stay away from I will not fund training for Nurses Aide. And the reason for that is that I am responsible for helping my client get the best possible position that they can as far as money salaries that they can support themselves an opportunity for advancement. Also some job where they can feel some pride and receive some community support and steam and if far as I'm concerned a daycare workers Nurses aides are deal with people on the lower food chain. These are our throwaway. People are disabled our children are elderly and until we as a society decide that we're going to honor these folk, even though they don't produce income for us that you know, we are they are consumers and as such if nothing else we could honor them because of what they consume and pay accordingly, but until that happens as an employment counselor will not fund these positions. And that explains that explains really why newspaper ads, for (00:47:04) example for this position go unanswered you betcha. There's no reason to answer them and it's hard for me to say to stand here today and say we want you to come work at nursing homes G after hearing all this who would want to and that that begins the discussion of how do we actually change this as (00:47:23) we have time to change people's attitudes we talk about something very difficult to change. How do we (00:47:28) change people's attitudes? You know what again? I think if I think it goes back to economics very honestly, I think it's based upon economics. These are non-producing producers of our society the children the disabled and the elderly and I think if we could as a society begin to look at them as consumers, I think we as a society would honor them more (00:47:52) well in Money Money always is an issue, but if you look at other cultures, for example, for example, the American Indian culture the way there. They honor their elderly in a very poor environment is similar to say in India and other countries that without much money they seem to be able to take care of older of older people and and they do that in many ways, but it's because those people are (00:48:16) honored by statement which Senator kiss Caden it brings us to the point of we are in good Economic Times in Minnesota. We've got money now if we are not able to address this problem when we are flush what in the world is going to happen during an economic downturn. I've been listening to this conversation and and reflecting on the fact that there's an old saying, you know, you can you can tell someone's values by looking at how they spend their time and where they spend their money and I've left a floor debate about how much we're going to spend on early childhood education to come and be on the radio with you today, and we're in the gauged in this big debate about tax reductions and tax rebates. And I just I find it a perplexing in an ironic that that in many ways what the problem is that the public has told us very clearly. They want tax reductions that they feel that they are being that they're being taxed too high. I had the same conversation yesterday with my husband as he was talking about paying our taxes yesterday, but the reality is is that we have a disconnect I think in our society from what our taxes paying our taxes and seeing the services that we directly receive be it having an elderly family member in a nursing home our children in schools or the roads we drive on and so it is it is simply the general we respond to what the general public tells us. They want and the general public doesn't feel a connection between the taxes. They pay in the service has their own family members receive and it I don't know how to solve that problem. We will do we're represented to represent our districts of the people we will We will do what they've asked us to do and reduce taxes and as we reduce taxes, that means we will not be giving the kind of increases that these people you've heard from today. Tell us are needed to be able to help stabilize this Workforce and that is that is pure and simple the reality of what the people want we will do and the people don't see this and don't tell us and don't don't value this in the same way that they value then there's also other social changes, you know, we have we have an era in which most families have both parents both adults in the family working and we have a lot of families where there aren't two adults in the family, and so there's some there's some cultural things about what we value as a society that then get reflected and not being available to give care and in the amount of taxes that were willing to pay and whole variety of issues. Let's take one more call Paul in Rochester. You've been waiting patiently on the phone. Good morning. Go ahead with your (00:50:56) comment. Good morning. First of all, thank you very much for having. It's on public radio. I really appreciate it. And so does my family and thank you to the senator and the other person there quickly very quickly. I simply want to say that I because I'm on the board of directors of a developmentally disabled institution which helps primarily young people which is no different than nursing homes or desperately looking for people. I would personally pay a higher tax. I would personally like to see a text to help directly go to this situation. I could see also other avenues. Why can't we take the lottery money and put it towards taxes? Why can't we charge a toll to the roads to the casinos? Let's get really creative. We need to truly help these institutions help. Our people Minnesota is a great state, I believe and we can come up with the money. I know we Also, I want to say in my personal case. My mother passed away a few years ago and I couldn't be with her. She wanted to live in a rural community on Western Minnesota. So I had to rely on people in the nursing home and over the years that she was there. She was there two years when she passed away. I personally went out to the nursing home and not only did I thank every staff person. I gave them a Christmas bonus because I knew they were making back then 6:22 an hour or whatever because they loved my mother. That's all I want to say. Thank you very (00:52:32) much. Thank you for your call center cascading are those possibilities? I'm sorry. I'm not sure what your question is in terms of putting some tax money to this specific issue is that I don't think that the current and current political climate. It is a possibility and I think we have a we you know, I would like to say one thing is that in terms of long-term care. We also have to look at what our personal responsibility is. Because in Minnesota, we rely on government to pay for all of long-term care. And so we have health insurance for acute care, but we don't have health insurance for long-term care and is I'm on the edge of that baby. Boom My Generation needs to look ahead and plan ahead because government isn't going to be able to afford even what we're doing now when all of us is you're going to talk about in your next hour go over 65, but I think we do have a also just a fundamental values discussion that we need to have in Minnesota about what is it we value and what contribution do we need to make through our taxes to the general Community? Thank you Senator. We're halfway through this Main Street broadcast from Rochester Our Guest this morning have been dr. Kevin Fleming Markus Persson and Senator Sheila Cascade and thank you all for joining us next hour. We'll turn our attention to the coming wave of senior Baby Boomers will ask our guests if the present long-term care system is going to be able to take care of all of us and if it's the kind of care we want when you're old and frail, what are the chances that you'll be able to stay in? Around home or Community. It's all ahead. We can we continue our Main Street special from Rochester after the news.