ST. LOUIS — A north ºüÀêÊÓƵ nursing home that abruptly closed Friday, leaving workers unpaid and some families unable to locate loved ones, had recently lost a special $1 million annual Medicaid payment.
The chaos following the closure of Northview Village Nursing Home continued to unfold Tuesday as workers, union officials and city leaders gathered in front of the building to air their anger at the shuttering of what had been the largest nursing home in ºüÀêÊÓƵ. Almost 175 residents were moved to more than a dozen different nursing homes over the weekend, sometimes without informing their families.
Exactly what led to the closure of Northview, a once-stable employer that occupied the historic former De Paul Hospital on the city’s north side, is unclear.
But industry experts say Northview was dealing with the staffing issues and low Medicaid payment rates that all nursing homes contend with, and because of its patient mix, was particularly exposed. In March, the 130-bed Riverview Care Center in south ºüÀêÊÓƵ closed for similar reasons, said Nancy Stevens, a dietician for nursing homes who consulted for Northview’s owners for years.
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“They can’t survive,†she said of the industry. “They struggle to make payroll. They struggle to make any kind of upgrades or investment.â€
Northview Village’s owner, Mahklouf “Mark†Suissa, of Chicago, declined comment on Tuesday.
“I’m not getting into anything,†he said.
On Tuesday, the building’s front entrance was boarded up. Paperwork was stuck in bushes. Packets of alcohol wipes, empty file folders and wheelchair parts littered the ground outside the building — the former DePaul Hospital.
Workers said residents were confused, and crying during the move. Residents’ family members were upset.
“I’m used to working in a nursing home, everything has to be done in an order,†said Hattie Baldwin, a certified medication technician. “People have to be notified before you take any steps — before you move anybody. I’ve been taught this 20 years. And on Friday I saw none of that.â€
Baldwin was working on the fourth floor, dispensing medications. Residents were taken away throughout her shift.
“It was chaos,†she said. “I’ve never seen anything like it.â€
Tuesday morning, Baldwin saw a former resident of Northview standing on the street. She wasn’t certain whether he was under the care of another nursing home.
Marjorie Moore, executive director of VOYCE, the regional nursing home ombudsman program, said her staff were still tracking down residents.
Financial stress
Suissa’s business, Healthcare Accounting Services LLC, owns two other Missouri nursing homes, Grand Manor in Grand Center and Cori Manor in Fenton. It also owns two Edwardsville nursing homes: University Care Center and Edwardsville Care Center, and Elmwood Nursing and Rehabilitation in Maryville. It owns another home in suburban Chicago.
Harvey Tettlebaum, a Jefferson City Husch Blackwell attorney who for 40 years has represented the long-term care and nursing home trade group the Missouri Health Care Association, agreed that low Medicaid payments endanger the industry.
“Every facility in Missouri is at risk,†Tettlebaum said. “I mean it’s ridiculous. I’ve never seen it this bad.â€
Nursing homes’ employment woes were exacerbated by the pandemic in 2020 as COVID-19 spread rapidly through a sick and elderly population and workers left. A tight labor market has persisted since the virus has receded, hindering efforts to staff back up. And nursing homes reliant on a large portion of low-income patients on Medicaid — as Northview was — have been especially at risk because Medicaid payments don’t cover their costs.
“People just left in droves, and you can’t have more residents than you can take care of — that’s the law,†said Tettlebaum. “They never recovered from COVID.â€
Adding to Northview’s woes, Tettlebaum said, was the loss of a roughly $1 million annual payment three or four years ago. The payment of federal funds is distributed by a nonprofit formed by the state’s nursing homes — the Nursing Facility Agent Corporation — and is given to the home with the most Medicaid patients.
As Northview lost staff during the pandemic, it stopped taking patients and fell out of the No. 1 spot for Medicaid nursing home care, Tettlebaum said.
“They were the largest Medicaid facility for years in Missouri,†he said. “They weren’t able to staff up, and to their credit, they stopped taking residents.â€
Northview is licensed for 320 beds, but only about half were filled when it closed.
Medicaid currently only covers about 80% of the cost of care in nursing homes, Tettlebaum said. And until last year, Missouri lawmakers and state officials hadn’t adjusted Medicaid reimbursement levels to nursing homes for over 15 years. When the state finally approved its plan to boost payments last year, it took the federal government months more to approve it, he said.
For Northview, which was almost entirely Medicaid patients, a faster approval from the federal Centers for Medicare and Medicaid Services could have potentially provided lifesaving cash flow.
“It was too little, too late for Northview,†Tettlebaum said.
Picking up the pieces
Northview workers said they first suspected something was wrong, Friday, when their paychecks didn’t arrive by direct deposit in the morning. But it wasn’t the first time that had happened, and even when they were paid late, the money had always arrived by the end of the day Friday.
Then some noticed that the human resources staff weren’t in — and they always worked on pay day, said Baldwin, the certified medication technician. Around 4 p.m., vans from other area nursing homes started arriving, to take residents to other facilities.
People who weren’t working at the time found out from their co-workers. One certified nursing assistant — who worked at the facility for more than 20 years — found out from a family member, who had seen the closure on the news.
Tuesday afternoon, workers gathered at a Service Employees International Union office in the Skinker-Debaliviere neighborhood. Staffers from the state’s Rapid Response Team, which is deployed after large-scale layoffs, explained how to file unemployment claims, and walked through the next steps workers should take to preserve their retirement benefits and sign up for health insurance.
A union staffer stepped in and wrote on a whiteboard the time and address of a food pantry a local church was providing, for the laid-off nursing home employees.
About two-dozen listened to details about how to navigate the unemployment call center, what paperwork they would need to fill out, and what support they could receive in finding a new job.
Jerry Simpson, a certified nursing assistant who worked at Northview for 11 years, said he was stressed, but surviving.
“It’s not right — I know that,†Simpson said. “This should never happen again.â€
The city is holding job fairs for the displaced workers on Friday and Dec. 27, from 9 a.m. until noon, in the first floor conference room of 1520 Market Street.