There’s no safety net: Jim and Claudia Carlisle sat on the deck of their home in West St. Paul on Wednesday. The Carlisles use personal care assistants because of their disabilities. With the state government shutdown, if one of their personal care assistants quits or has to leave, they can’t hire a new person because of the need for background checks. They have no family in the area, so there is no safety net for them.
Cracks in the system of care for sick and frail Minnesotans are emerging this week as the loss of state services begins to disrupt providers' ability to maintain staff and facilities.
The state's oversight of hundreds of nursing homes, home care agencies and other programs that serve elderly and vulnerable adults as well as programs for young people has been dramatically curtailed or cut off. Routine inspections of nursing homes, hospitals and other facilities performed by the Health Department have ended. The department's section that investigates complaints in health facilities has trimmed its work to only the most serious complaints of abuse and neglect.
"Staff in all areas of the department are doing the best they can with limited resources," said John Stieger, a Health Department spokesman.
In some areas, there isn't anyone to respond to problems. Over the holiday weekend, a storm ripped the roof off the city-owned nursing home in Belview, Minn., knocking out power and leaving as many as 15 rooms soaked with rain. Twenty-five residents had to be evacuated.
The facility needs state approval to rebuild. But administrator Jim Broich can't get the safety checks required by state law because the engineers who review plans were laid off.
"I think I need approval from the Health Department engineering people before I go much further, but I'm not even sure what the right questions are," Broich said.
As a result, the residents remain scattered at other nursing homes and 65 employees at the facility in the tiny town 125 miles west of the Twin Cities are out of work. One of the nursing homes that took residents is willing to hire a few workers from Belview but can't, because state layoffs included the office that conducts the required criminal background checks.
"These are real people out here who are hurting," Broich said.
The state's two nursing home associations are scheduled Thursday to ask a court-appointed special master for relief. They, along with other groups and Gov. Mark Dayton, are seeking to reopen the background checks office. Nursing homes and assisted living facilities face 25 percent annual turnover among their 90,000 employees across the state, requiring more than 400 criminal checks each week.
The problem extends to home care agencies, day cares and other care businesses. Overall, the state conducted 38,000 background checks last year.
"It's the No. 1 problem we're getting calls about from our members," said Jennifer Sorensen, executive director of the Minnesota HomeCare Association. "Today it's a hassle, but in two weeks it could be a very big problem."
Some smaller agencies and residents who hire personal care attendants are already facing critical shortages.
At People Enhancing People, a St. Paul-based nonprofit that helps oversee aides for people with disabilities, 10 prospective employees are unable to go to work because of the background check problem. At least one client could be forced from her home because she lost an aide and can't get a replacement.
"If you don't have the staff, you're going to end up in a nursing home," said Beth Ismil, executive director of the nonprofit. "It's a very scary time."
Licensing boards for all professionals, including doctors and nurses, were closed as a result of the shutdown. That means no disciplinary actions are being taken and no new licenses or renewals.
David Bender, who grew up in Golden Valley, was hoping to return to Minnesota this year to practice as a pediatrician. He just completed a medical residency in New Jersey and applied in May for his physician's license in Minnesota. He needs the license to take his American Board of Pediatrics exam and doesn't know if he'll be able to complete a license from another state before he has to take the exam in October. If he misses that deadline, it may hamper his career. Bender suspects he's not the only young medical professional caught up in the system.
"I'm at a pretty significant risk of not getting a license if things don't resume," he said.