Marvin Querry, 86, was on his tractor, planting rye on his 770-acre western Missouri farm, when the call came in early November.
It was the social worker from Barone Alzheimer's Care Center, where Querry's wife, Diane, is a resident. The facility would be closing because of financial hardship, she said, reading from a statement.
It was an agonizing moment for Querry, a retired physics professor and former executive dean for academic affairs at the University of Missouri-Kansas City. "I was stunned," he said. "Where could I find another place as wonderful to care for Diane?"
It's rare to hear people talk about a nursing home the way they talk about this 40-bed facility in Nevada, Missouri — a city of nearly 8,300 people near the Kansas border — with deep affection, respect and gratitude.
"We couldn't ask for a more loving and thoughtful staff than those who work at Barone," a woman whose mother lives there wrote on a petition to save the facility. In a business where staff turnover is constant, many of Barone's staff members have been there for five years or more.
"The care there, it goes beyond words," said Kay Stevens, whose 94-year-old mother moved into Barone in May. "The residents are treated so well, and it's such a joyous environment."
But even a sterling reputation and deep community support can't overcome a stark reality: The future of nursing homes is deeply uncertain as older adults and their families shy away from care in these institutions, where nearly 142,000 residents have died of covid-19.
With ongoing expenses related to the pandemic and beds sitting empty, 54% of nursing homes report operating at a financial loss, according to a national survey released in June by the American Health Care Association, a long-term care trade organization. Only a quarter are confident they can make it through the next year or beyond. At least 134 nursing homes closed their doors in 2021, on top of 170 closures in 2020.
Although covid relief funding has helped many nursing homes in the short term, "things are much more uncertain going forward," said David Grabowski, a professor of health policy at Harvard Medical School.
Barone's fortunes reflect these broader trends. Before the pandemic, all 40 beds were full, and there was a waiting list of 25 people. About 60% of patients paid privately for care; the other 40% were on Medicaid, the government's program for people who are poor. The facility was making money, although not a lot.
Then covid began circulating, and an outbreak of 32 covid cases and four associated deaths in the weeks after Thanksgiving in 2020 created enormous stress. Querry's wife, Diane, 76, was one of the residents who became ill, but she recovered.
Between January and October of last year, Barone's financial losses totaled $675,318, according to data from William Denman, city treasurer of Nevada, which owns the facility. Even more alarming, another city-owned nursing home, Moore-Few Care Center, which has 108 licensed beds, lost more than $1.1 million in the same period.
Moore-Few, which does not include a locked area for patients with dementia, experienced a covid outbreak after a staffer came to work with symptoms in October 2020. In the following weeks, 47 residents contracted the virus, and 10 died. A subsequent investigation resulted in an "immediate jeopardy" citation from the Centers for Medicare & Medicaid Services, a signal of serious problems that pose a risk to residents and mandates quick action, and a fine of $144,693. Investigators found that the nursing home had not adequately screened staffers for covid or prevented those with symptoms from working.
Since then, about half of Moore-Few's beds have remained empty.
Financial and operational problems of this sort "can't continue," said Denman, a retired businessman who grew up in Nevada. "We're going to lose both of these homes if we don't do something soon."
But there's considerable controversy over how to move forward.
Marvin Querry has become an activist — a role he never anticipated playing at this stage of life — leading the opposition to Barone's closure.
The day after he learned of the proposal to close the home, Querry asked several pointed questions at a meeting of a five-member board that oversees Nevada's nursing homes. More than 100 community members attended that meeting, many of them angry and distressed. The board ended up tabling plans to vote on the home's closure for now.
A few days later, with his daughter’s help, Querry created an online change.org petition requesting detailed financial information about Nevada's nursing homes and protesting Barone's closure. Within a month, it had gathered more than 1,500 signatures.
Also, Querry attended city council meetings and ran ads in the local newspaper three times a week featuring the petition. "I've spent almost $3,000 on these ads. I'm willing to spend $30,000 — or more — because the care [at Barone] is unsurpassed."
He wants nothing less for Diane, 76, whom he's been married to for 47 years and who's lived at Barone for two years. Every evening, Querry goes there to feed her dinner.
Karen Hertzberg, who owns a local furniture store and whose husband, Steve, 68, moved to Barone in September, feels equally strongly about saving the facility. "We need time for conversation, for research, for finding funding," she told me. Steve has severe multiple sclerosis with related cognitive dysfunction and is completely dependent on assistance.
One option could be a new city tax that would pay for Nevada's city-owned long-term care facilities. When the city hospital faced financial trouble several years ago, voters passed a dedicated tax. It generates about $800,000 a year for the hospital, whose financial difficulties continue.
"We rallied to save the hospital, so why aren't we saving our seniors? We need to stand up and fight for this," said Jennifer Gundy, a lifelong resident of Nevada and executive director of On My Own, a center that helps older adults and people with disabilities live independently.
But what if current trends continue beyond the pandemic? What if families shun nursing homes and keep loved ones at home? And what if short-term solutions — grants for covid-related funding, contributions from donors, new city funding — don't make up for financial shortfalls for long?
Faced with the controversy over Barone Care Center's potential closure, four members of Nevada's long-term care board resigned. As four new members joined the board in mid-December, Moore-Few's administrator and up to a dozen staffers also tendered their resignations. The sense of crisis seems more acute than before.
Officials are sending mixed messages. "Our intent is to do whatever has to be done and absolutely keep [Barone] open," said George Knox, Nevada's mayor. "I don't think anything is decided yet," said Judy Campbell, who chairs the city's long-term care board. "We just have to go back to square one and see if there's any chance of keeping Barone going."
In the meantime, community members are determined not to back down. "I have no idea what will happen, but I'm not giving up," Querry said. "I'm going to do everything I can to save this place that's so important to all of us."
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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.