This week, problems with the 15-year-old program, created to combat the turnover rates of large nurse workers in the state, have rekindled. Providers are still wondering if the money starts flowing, that is, if it will change their misery.
Iowa Performance Program Salaries are aimed at recognizing nursing facilities that “provides quality care and adequate access to beneficiaries of medical assistance programs in a cost-effective manner,” according to the state Department of Health and Human Services.
However, the momentum behind this idea appeared to peak in 2009 to coincide with its creation.
“Congress did not fund the program in 2010 and has not funded the program since,” said a December 2024 report from Iowa Health and Human Services.
The 2024 Nursing Facility Direct Care Worker Turnover Report revealed an astonishing turnover rate that could be possible for some state providers to revisit their P4P program.
Certified aides recorded a turnover rate of 77% in 2024, which the study revealed, but the turnover rates for registered and licensed practical nurses were 66% and 68%, respectively.
Iowa president and CEO Angela Schneff said it is part of the reason behind many workers leaving the industry.
“It is estimated that Medicaid only covers about 80% of the cost to care for our seniors. With the majority of funding for Iowa's aging services coming from the government, providers are unable to raise fees to compete with companies like Amazon, Starbucks and McDonald's,” she said.
Many location providers are looking for solutions like the P4P program in Iowa. However, providers say they are investigating that the program may not be a promised program.
A research study in health services examined changes in nursing home quality after P4P programs were implemented in various locations around the time Iowa first introduced the model.
Between 2001 and 2009, eight state Medicaid agencies adopted P4P programs in nursing homes, with certain measures improving after implementation, but the percentage of residents suffered moderate to severe pain, but the numbers that developed pressure pain overall showed that Medicaid-based P4P for nurses did not yield a consistent improvement in HSR studies.
In the meantime, Iowa operators have been self-creating in ways that recruit and maintain talent, Schnepf has confirmed, including offering free or reduced price services in the hopes of such incentives lowering the disastrous turnover rates reported to HHS.
“The community and providers are also able to accommodate flexible schedules to provide on-site day care to employees’ children, allowing workers to return home with their families for dinner and mission-based organizations.
Current financial tensions can place direct caregivers who are passionate about the industry in challenging situations, as love for the elderly is not directly comparable to their ability to live a good financial life.
“Employees have inflation in bills and combat. Government funds, especially Medicaid, need to increase,” Schneff said. “The ability of providers to pay competitive wages is essential to attracting and maintaining these workers.”
