CROSBY - It was standing room only Monday night the Cuyuna Regional Medical Center (CRMC) Governing Board Room, with people lined up along the walls of the board room and spilling into the hallway.

Nearly a month after hearing concerns from residents and staff members during a governing board meeting, several people were given the opportunity to speak before the board. And the board voted to take action on several initiatives aimed at answering repeated concerns about too few staff members to properly care for CRMC's Care Center's nursing home residents.

"This is a critical and important issue to our area," said Kris Hasskamp, former area legislator who has been talking with staff members and nursing home residents after issues were raised. Hasskamp said she admired CEO John Solheim's work in expanding the facility. She said the values in creating the hospital involved treating everyone with dignity and respect. "The issue here is about trust. It's not about bricks and mortar."

Hasskamp said she was particularly concerned about the number of people who have left the organization. She noted Roger Twigg, board chairman, and his comments comparing Solheim to a new coach who brings in his own staff and who may have a different approach. Hasskamp said sometimes the new approach doesn't fit.

Hasskamp said she now sees staff members who are so frozen in fear and almost abused by the fear of losing their jobs.

Care Center concerns

Verna Spalj, 89, a 17-year care center resident, had the room's attention as she spoke from the front of the room seated in a wheelchair. She spoke on behalf of Care Center residents. Spalj said the broad sweep to remove local department heads and long-time employees has garnered a lot of negative attention.

"The outcome is a ripple of worry that follows employees throughout their work day," Spalj said. "It worries me, which of my good caregivers will be next."

Spajl said residents, family members and staff tried to talk about their concerns before bringing things up in a public meeting, but the administration was focused on an effort to operate the CRMC their way without advice of the board or input from the public.

"This could be their downfall," Spajl said. "... I am not a guest of yours. This is my home. ... Our cries for your help are sincere and based on sad facts. We await your action."

Steps taken by the governing board Monday included authorizing adding staff to the Care Center to account for 20 more hours per day or basically four full-time equivalent positions. With pay and benefits, the added staff is projected to cost $161,040 annually. The Care Center, CRMC reported, has been operating on a deficit for years, ranging from a high of $984,620 in 2008 to a low of $12,054 in 2013. It is projected to be in a deficit of $115,069 in 2015.

Staffing difficulties

Issues outlined by CRMC included a difficulty industry-wide and statewide in terms of attracting staff. Cuyuna Regional Medical Center reported its starting wage for certified nursing assistants is 28 percent higher than other facilities in the area at a comparison of $13.93 to $10.90 per hour. As other independent nursing homes typically make 2-3 percent for a profit margin, CRMC said that hasn't been the case at the Care Center due in part to it's higher wages, larger staff and benefits. In the last eight years, the organization stated it has subsidized the Care Center by $4.6 million.

Part of the issue is a nursing home reimbursement system CRMC describes as broken and unable to adequately reimburse costs for care and staffing. A bill before the Legislature this years to improve the state's reimbursement by $200 million would go a long way to support care centers, CRMC reported.

Monday's staff presentation outlined how many nursing homes have closed in recent years. Twigg said the Care Center would have been one of those if it was an independent operation without the medical center.

About 40 people attended the board meeting in addition to staff and board members.

Employee concerns

Hasskamp said she was concerned about the loss of local talent as people leave the medical center and move out of the area. Mary Aulie, a biller in the CRMC Care Center, was employed at CRMC for seven years. Aulie told the board the administration has created a hostile atmosphere. Aulie resigned and took a job at the Aitkin High School. Aulie said she was told she was no longer the right fit at CRMC.

Lisa Olds, oncology nurse, said she was a happy employee for 14 years and loved her job. All that changed four months ago. Then she said she was told she spent too much time with her patients and it was the start of a disciplinary process she felt was speeding toward her dismissal. In 31 years of nursing, she said she'd never had so much as a verbal warning. In a short time, she said the job became extremely stressful. She began to worry about losing her home if she couldn't find other work. She resigned and found a job at an assisted living center in Brainerd. She said if all the experienced staff is eliminated who will mentor newcomers.

"I think there is something fundamentally wrong here," Olds said after the meeting.

Earlier this month the CRMC Board of Governors had a strategic planning retreat to discuss the staffing challenges. At that session, the board looked at staffing shortages, noting the fall and early winter were particularly difficult with 14 job openings. The staff shortage, CRMC reported, was complicated when staff and Care Center residents were affected by influenza. Since then, CRMC reported 12 of those open positions were filled.

Measures the board green-lighted Monday included suspending indefinitely a plan for senior staff bonuses, which were never given. A staff survey will be completed by an independent organization. The last one was conducted in 2012.

Jolene Lundquist, board member, urged employees to take part.

"We need to hear from you," Lundquist said.

Twigg said the recommendations before the board were a starting point for the board to help the organization move forward and learn from here. "We will be doing the best we can," Twigg said.

Lundquist said the question for the board is how did things get to this point.

Board member Al Ebnet suggested the board meet after the regular session in a closed meeting, but when that was questioned for being compatible with the open meeting law, the board members did not stay for an addition session.

Nancy Stratman, senior services administrator, said one option CRMC is pursuing is using students to help during the busiest time of day - the supper hour and getting residents ready for bed. She told those gathered the people at the Care Center know their work is a matter of the heart and the nursing home staff members are unsung heroes entrusted to serve people's loved ones. She said 66 nursing homes have closed since 2000. Stratman said other areas they are working on is to eliminate the invisible wall between the nursing home and the hospital when it comes to care issues.

Dignity and aging

Peggy Anderson said she started at CRMC 10 years ago to help feed people, a position the Care Center no longer has. Now she said there are 12 residents in the Alzheimer's unit and three aides to feed them.

"That means some aren't being fed," she said.

Matt Fort said the board's news on Monday was promising. It took a packed room at the last board session to get results. The Fort family members said they planned to continue to be a presence and vigilant. Matt Fort said the number of Minnesotans turning 65 in this decade, about 285,000, will be more than the past four decades combined and if something isn't done one in five Minnesotans will be able to experience a short-staffed nursing home first-hand. He later noted that can mean a 45 minute wait for assistance to the bathroom at the Care Center.

Becky Thiesfeld, human resources, said when the economy picks up it can be difficult to attract employees and they are working with Central Lakes College and the WorkForce Center and have a $5,000 scholarship program to help employees advance.

"In my dad's case, and for the people of the his generation, his fight began as a boy during the Great Depression - just to survive." Matt Fort said. "Then, as a young man, he fought for his country in the U.S. Army in the Korean War. When he returned home he worked 800 feet below surface in the underground mines and then spent nearly three decades fighting for safety as chief of police.

"After a life of dangerous careers, never in my wildest imagination would I have thought that the greatest fight he'd have would be to get a few, simple things done in a nursing home."

Matt Fort said the men and women in the Care Center don't have time for circuitous answers, temporary Band-Aids or bureaucratic roadblocks.

"Companies cannot feel suffering. Bureaucracies cannot feel suffering. Only individuals can feel suffering," Matt Fort said. "We all want answers. We want continued action. We want to hear clear plans about striving to become the best long-term care facility in the state. We want to hear timelines. We want to hear real numbers behind percentages and want to hear sources."

"At the very least, we owe them the dignity and compassion they deserve..."

RENEE RICHARDSON, associate editor, may be reached at 855-5852 or renee.richardson@brainerddispatch.com. Follow on Twitter at www.twitter.com/Dispatchbizbuzz.