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Closures hit R.I. nursing homes amid staff shortages, experts share potential solutions

Low Medicaid reimbursements contributed to financial challenges for nursing homes, advocates say

In 2020, the nursing home Hallworth House closed its doors permanently. 

According to CEO Stephanie Igoe, Hallworth House struggled due to its admission of more patients with complex conditions and Medicaid beneficiaries, which decreased the reimbursements provided for the highly specialized care of the facility. 

Amid challenges related to Medicaid reimbursements and labor shortages, other nursing homes like the late Hallworth House have shut down across the state in recent years. Since 2020, six nursing homes have closed statewide, forcing the relocation of more than 100 residents, according to Governor Dan McKee.

But not all nursing homes have fared the same: Bethany Home of Rhode Island, which Igoe also oversees, is fully staffed, she told The Herald. She attributed the facility’s success to its admission of patients with fewer complications and access to Medicare or private insurance, which have higher reimbursement rates of providers. 


Across the country, nursing homes with more vulnerable patients — including those of minority identities or lower income backgrounds — continue to face staffing challenges after faring worse through the COVID-19 pandemic. 

According to Elizabeth White, assistant professor of health services, policy and practice at Brown, these staffing challenges have always plagued the field. 

“This was a vulnerable workforce even before the pandemic, with staffing shortages and high turnover rates,” White explained, who worked as a long-term care nurse before her academic career. “The pandemic just made all of that worse.”

In 2021, McKee passed a law requiring monetary penalties to be paid by nursing homes that did not meet minimum staff numbers. He suspended the mandate — which was never enforced — late last year because of the industry’s labor shortages.

According to White, models of care in nursing homes, which differ from those in other healthcare settings like hospitals, also contribute to staffing shortages. Unlike hospital nurses, care providers in nursing homes could be responsible for dozens of patients during their shifts, she explained.

Kathleen Heren, lead ombudsman for the Rhode Island State Long Term Care Ombudsman Program, wrote in an email to The Herald that families agonize over placing relatives in nursing homes. Staffing ratios in nursing homes are at the forefront of families’ minds, she added. 

Heren believes that a “staffing mandate nationally is a great idea if homes could find staff,” but if the state staffing mandate went into effect today, “few homes” would meet requirements.

Due to the downsizing of nursing homes, Heren’s office at the nonprofit R.I. Alliance for Better Long-Term Care is currently relocating residents. The challenges currently facing nursing homes disproportionately impacts residents of color, low-income residents and those with disabilities, she wrote.

Heren and Igoe both pointed to low Medicaid reimbursements as a contributor to nursing home closures.

“I couldn’t keep staff (at Hallworth House) no matter what I did,” Igoe told The Herald. “Not necessarily because of (COVID-19), but because of low reimbursement from Medicaid. We simply ran out of money.”


For Heren, increasing the Medicaid rate for nursing homes may ease the facilities’ challenges, along with higher wages and more opportunities.

According to White, better pay and opportunities for nurses, along with “strong organizational leadership,” could also help improve nursing home staffing. 

But, in the long term, nursing homes may need to explore entirely new models of care, White added, pointing to the Green House model, which establishes smaller scale facilities and emphasizes self-sufficiency and community, as an example.

“There’s work around really innovative solutions out there, but these are very, very complex issues,” White said.

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Jaanu Ramesh

Ranjana “Jaanu” Ramesh is a Bruno Brief-er, photographer and Senior Staff Writer covering science & research. She loves service, empathetic medicine and working with kids. When not writing or studying comp neuro, Jaanu is outside, reading, skiing, or observing Providence wildlife (ie: squirrels).

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