When the COVID-19 pandemic was truly raging, there was a considerable public focus on nursing homes since they were disproportionately affected. Yet that focus did not translate into sustaining federal assistance for New Hampshire facilities.
Instead, federal assistance to nursing homes disproportionately rewarded states that allowed themselves to become COVID-19 petri dishes, making the number of nursing home deaths appear lower compared to the general population. Consider a state red hot for the virus. Over two months alone, through a distribution misnamed the “quality incentive payment,” the average South Dakota nursing home received $217,699 – over eight times what the average New Hampshire facility received ($26,860).
It is a perverse world indeed when a state with two-thirds our population but 67% more deaths was effectively rewarded for completely failing to control the virus.
A federal Coronavirus Commission for Safety and Quality in Nursing Homes, comprised of an impressive group of experts, issued a thorough report last September. It recommended such responses as governmental “funding streams for nursing homes to redesign and/or strengthen facilities against infectious diseases” and immediate “hazard pay for direct services staff of nursing homes through appropriate federal or state funding mechanisms.”
There was, and is, no federal movement toward implementing these ideas. Thus the 186-page report was an empty study exercise, not unlike a 130-page report issued by the bipartisan Commission on Long-Term Care in 2013. That 2013 report, ardently declaring “(t)he time to act is now,” was met with a collective policymaker yawn. And that was no different than the reception for a previous call to action on long-term care in 1990, the product of the bipartisan congressional Pepper Commission, about which its chair, then-Sen. John Rockefeller, presciently wrote, “Some may greet the report as a nonevent – just another set of recommendations to sit on the shelf(.)”
Currently, states are left to the patchwork that is the federal-state Medicaid “partnership.” It is a patchwork where the federal government (thanks, in no small part, to donor state taxpayers like New Hampshire’s) pays 78.31% of nursing home costs in Mississippi, but just half in New Hampshire. A lot more can be done with more federal investment. For example, with the federal government footing 60.22% of the bill, Oregon’s basic nursing home Medicaid rate is $351.61 a day compared to New Hampshire’s $187.60.
Our congressional delegation has tried, within this imperfect system, to secure more COVID-19 provider relief resources, which is appreciated. Yet looking into the future, are we simply bandaging the hull of the Titanic? Should we not be focused on reform that would make the federal government more fully, if not entirely, responsible for the Medicaid costs of the care it regulates in over 15,000 nursing homes nationwide?
Already there has been recognition that more federal funding is needed for home and community-based services, with the federal Medicaid matching rates for those care settings increased by 10% through March 31, 2022. While a welcome development, that could create a bow wave of future state responsibility if the larger federal investment is not made permanent. And it is permanency, not piecemeal, that we need now when it comes to federal policies toward the aged and infirm in all settings, whether at home or in a facility.
The pandemic has highlighted the vulnerability that comes with age. So far this year, over 77% of those dying from COVID-19 were 65 and older, with those 75 and older accounting for over half of all deaths nationally. These lives mattered. Our society is aging, and future pandemics likely await.
(Brendan Williams is the president/CEO of the New Hampshire Health Care Association.)