I think it was Benjamin Franklin who said, “Nothing is certain in life except death and taxes.”

I could write and have written many reports on tax implications for farmers, but I don’t know that I have written much on the topic of death. And this isn’t really on death, but rather on the potential need for long-term care in a nursing home, which more and more becomes less a place to rehabilitate and more and more, a place for acute care needs and a final home before we pass away.

My wife is on the board of an area senior living complex, so she occasionally brings me up to speed on costs, regulations and such that are impacting the business of providing good long-term care for those in need when they are at their most vulnerable.

President Biden is proposing a plan to set minimum staffing levels for nursing homes. Under the proposal, nursing homes must provide 2.45 hours (2 hours and 27 minutes) per resident day of care from nurse aides, exceeding standards in all states. This means a nursing home would need roughly 10 nurse aides per each eight-hour shift in a facility with 100 residents. Under the proposal, 68% of nursing homes would have to hire additional nurse aides to meet this requirement.

“The proposal also makes clear that the numerical staffing levels are a floor–not a ceiling–for safe staffing. Under the proposal, nursing homes would have to undertake a robust assessment of their particular facility, including consulting with workers and their representatives, to determine whether higher levels of staffing and what staff competencies are needed to meet the needs of their particular resident population.”

Recognizing that nursing homes in rural areas may face greater challenges and require greater time to hire additional workforce, the proposed rule would give most nursing homes three years to meet the new standard for nurses and nurse aides, and nursing homes located in rural areas would have five years to meet the new standards.

Now this sounds great … who can argue with having better care for our elderly or rehab residents? The problem, however, that the Biden adminis-tration’s plan does not address, nor account for, is how and where to get the staffing to meet these new proposed guidelines. This is like expecting you to plant 1,000 acres in a one-day period before it rains, using a four-row planter … with no way to access a bigger planter or the labor to run the planter. It can’t be done. Using the mandate above of 10 aides per eight-hour shift for a 100-bed facility … that’s 30 aides. You just can’t magically find them, especially in our rural areas. Wages have been raised significantly to attract good help, but that has not been enough to satisfy the needs of our facilities.

Temp agencies have benefited by the shortage of health care workers, serving as a stop gap for nursing homes who obviously need the staff, can’t find them or keep them, but must, and want to maintain adequate aides to serve the needs of their residents. The cost of using these temp agencies was/is taxing the financial limits of many of our senior living facilities so much so, that Iowa lawmakers considered a proposal from the nursing home industry to cap payment rates that staffing agencies could charge for their temporary nursing services, “limiting those costs to no more than 150% of the statewide average wage paid the previous year for staff professionals.” For lack of a better term, it almost seems as though price gouging is going on.

Even if a facility could pay the grotesque amount of money charged by the temp agencies to fill their unmet staffing needs, there is an issue of quality of care and ability to develop a relationship with residents needing care.

When you are using only highly paid temporary staffing that comes and goes from any facility, you lose that relational component of providing high quality care. The temp workers aren’t there long enough to develop a relationship with the residents, they are getting paid more through the staffing agency, and thus that adds complexity to those staff members that are there constantly, doing good work and not earning what their temp counterparts are earning. It becomes a vicious circle.

Both my dad and my father-in-law spent their final years in a nursing home, and from experience I can tell you that the relational component was an important part of the equation of providing quality care for them. Their favorite aides and nurses got to know them as people, as “old” farmers, got to know our families, would listen to our dad’s stories and would share jokes/etc. with our dads. You can’t get that with a temporary worker.

My wife and I were able to get what is called “Short Term Care” insurance for not if, but when the time comes that we need the care of a nursing home. Long-term care is not as readily available these days as it used to be, so the insurance industry has gone to these various short-term care insurance policies. We were able to get ours through a group plan promoted by the Iowa Corn Growers Association. Approval is not guaranteed but we were eligible to apply. While it won’t cover the entire cost of our care, depending on how long we live or need those services, it will likely help “save the farm,” meaning our policies will provide some coverage before we’d have to kick in more.”

I intend to do as my father-in-law suggested once that policy is depleted — leave the back door open and let me wander out in a blizzard.