Brendan Williams is the president and CEO of the New Hampshire Health Care Association.
New Hampshire has the nation’s fourth-lowest unemployment rate at 2.1%, and nationally there are almost two job openings per every unemployed worker.
There were almost two million job openings nationally in May in the health care and social assistance category alone. Presumably, those openings included the almost 400,000 positions lost since March 2020 by nursing and residential care facilities.
For those long-term care facilities, what was a staffing crisis prior to the COVID-19 pandemic is now a catastrophe, despite all efforts to avert it. Academic research shows nursing homes have led all health care sectors in wage increases during the pandemic.
Indeed, a survey of New Hampshire nursing homes by the regional accounting form BerryDunn found wage costs went up 23.7% from 2019 through 2021, counting staffing agency utilization, or 19.5% excluding contract labor. Such costs greatly exceed the Medicaid reimbursement paid for most nursing home residents, as do other inflationary costs, including the soaring costs of food and fuel.
Even with better pay, facilities just cannot find workers, forcing a reliance upon out-of-state staffing agencies to simply augment, not expand, the workforce.
The state itself has not been immune, just entering a two-year, $7.6 million contract with a California-based agency to staff the New Hampshire Veterans Home, which has been operating with a 37% staff vacancy rate. The state also deployed staffing agency personnel to select nursing homes to ease the burden on hospitals that could not discharge into the nursing home setting.
In an ideal world, the state would resurrect the wage stipends it utilized in 2020 for those long-term care workers serving Medicaid clients. If there was any defect to that approach, it was that providers without Medicaid clients were struggling too: the state had to triage. A Senate bill to restore the stipends was introduced this last session but shelved despite a committee report noting the intent was “noble.”
Noble indeed, but, as much as providers would like to see it, it’s unrealistic to expect the state to make such an open-ended commitment. The COVID-19 Long Term Care Stabilization Program cost $98.1 million according to the state’s dashboard, and that over a period of just months. It was paid for by the state’s Coronavirus Aid, Relief, and Economic Security (CARES) Act funding, but those were one-time monies.
A more recent, and sustainable, example of state relief that could be provided to sustain long-term care would be the COVID-19 Impact Long Term Care Program. Also funded through CARES Act funds, it provided grants of $2,500 per Medicaid bed based on a facility’s census on September 30, 2021. It provided an additional $2,500 per-bed grant as an incentive to increase occupancy, but, regrettably, most facilities could not claim this because they simply could not find the staff to increase occupancy.
New Hampshire could, as most states have, provide additional grant assistance by now using its American Rescue Plan Act funds. In Massachusetts, for example, nursing facility staff qualified for a one-time $500 bonus payment this year under the COVID-19 Essential Employee Premium Pay Program, while ARP Act monies were also appropriated to address nursing facility workforce shortages, through a ”Workforce Supplemental Payment,” and facility capital improvements.
Sometimes it takes the worst to capture the public’s attention. In Nebraska, facility closures compelled the legislature in April to override a gubernatorial veto and give facilities a 20% funding increase. Outright closures that displace staff and vulnerable residents alike are tragic, but what we have seen in New Hampshire is more subtle.
So many beds have been taken offline, and admissions denied, that it is as if we have lost several facilities. We must act now so we do not lose any entirely.