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My Turn: State leaders show they value long-term care



For the Monitor
Sunday, June 18, 2017

For long-term care providers, the 165th session of the New Hampshire General Court looked bleak. It began with the state proposing a two-year funding freeze, despite a long-term care staffing crisis rocking the state with the nation’s second-oldest population.

A national accounting study found New Hampshire had the third-worst gap between state Medicaid payments and costs for nursing home care (63 percent of residents are on Medicaid). Other long-term care funding is neglected, too.

For example, Medicaid payment for assisted-living facility care, meals and housing has been $49 a day since 2010. This funding shortfall is especially dangerous now, because all providers must compete with a booming service economy, where even a donut chain offers wages exceeding what the state will reimburse for licensed nursing assistants. Quite apart from the dignity of caregivers pursuing living wage dreams, what of residents who must endure turnover and unfamiliar faces?

Last month, the Granite State Poll asked whether New Hampshire residents would favor a nursing home funding increase even if it came at the expense of the Rainy Day Fund and business tax relief. Seventy percent said that they would. Mercifully, within the construct of a no-new-taxes budget, and with a very conservative revenue forecast, House and Senate budget conferees listened to constituents.

The budget compromise would provide modest increases in reimbursement for all facets of long-term care, including the Cedarcrest Center for Children with Disabilities. This can only help ease the systemic staffing crisis.

Notably, the budget compromise would provide this additional long-term care funding while at the same time increasing the Rainy Day Fund and providing business tax relief. Reasonable minds, and the two parties, can disagree about all of the priorities encompassed by the budget, which was limited by a very conservative revenue forecast.

However, people who are cared for, and work, in nursing homes can only express gratitude to Senate President Chuck Morse, particularly, for his leadership on long-term care funding. Both parties on the Senate Finance Committee had supported this aspect of the budget.

We hope the House approves this just approach. New Hampshire must move away from “balancing” its budget on caregivers’ backs by ignoring Medicaid care costs.

For example, we represent nonprofit, faith-based facilities that are in the business of charity – including the seven nursing homes run by New Hampshire Catholic Charities – and yet find themselves providing charity to the state itself. That’s morally untenable.

The state budget cannot rely upon church collection plates. Three-quarters of care costs are wages, and many facilities are already unable to staff all of their beds, leaving no room to economize further.

Without a funding increase, we would see a hastened pace of facility closures, with the pending closure of the 62-bed Crotched Mountain Specialty Hospital, and last year’s shuttering of New London’s 45-year-old Clough Extended Care Center being canaries in the coalmine. Caregivers, support staff, and residents will be displaced – in some cases to other counties. Place-bound elderly spouses of residents, so many of whom can no longer drive, would find themselves unable to visit their loved ones.

Caregivers are already frightened by the prospect of over-$1.4 trillion in proposed federal Medicaid cuts between President Donald Trump’s proposed budget and the American Health Care Act passed by the U.S. House. It is nice to see that we have state leaders in Concord valuing care.

(Brendan Williams is the president and CEO of the New Hampshire Health Care Association.)