In 1990, the U.S. Bipartisan Commission on Comprehensive Health Care recommended that the federal government pay for home care and the first three months of a nursing home stay. It was also recommended that the federal government pay for long-stay nursing home care where a resident would otherwise deplete personal assets beyond a “floor of protection.”
Nothing came from these bipartisan recommendations, just as nothing came of the 2013 report to Congress from the U.S. Commission on Long Term Care. Our nation has no long-term care policy, despite the longstanding awareness that the Baby Boomers would create a silver tsunami of long-term care need. Even as Congress ties itself in knots over subsidizing health insurers, states fend for themselves when it comes to long-term care.
Though today twice as many baby diapers are sold as adult diapers, Dr. David Shulkin, Veterans Affairs secretary during President Trump’s first term, devised a “Cradle to Cane Ratio” that noted the volume of adult diaper sales will surpass baby diapers by 2034. And who will be caring for our elderly citizens in 2034? Already children are outnumbered by those 65-and-older in 11 states, including New Hampshire. And New Hampshire nursing homes offering good wages and benefits are already turning away prospective residents because the facilities cannot staff all the beds they have.
We must build a sturdy bulwark for the growing age wave lest it drown us. There are reasons to worry. Governor Ayotte and the Department of Health and Human Services deserve enormous credit for leveraging Rural Health Transformation Program funding out of President Trump’s budget reconciliation law, obtaining an award 26% larger than Massachusetts, for example. My hope is this money can shore up our dire direct care workforce needs. However, by 2028, unless amended, that law also begins significantly decreasing our state’s Medicaid resources.
On Jan. 1, New Hampshire nursing homes suffered an unplanned blow when the complex Medicaid system, transitioning from one model to another, produced severe cuts for many facilities. While these were partially offset by a much-appreciated fund transfer engineered by Gov. Ayotte and DHHS, care funding at 33 of 73 facilities was still cut, and for 19 facilities quite sizably at over $10 per resident, per day. Worse, even without such cuts, we are one of the only five states with a “Budget Adjustment Factor” that reduces full Medicaid payment rates to whatever legislators appropriated. As a result, all 73 nursing homes are shortchanged daily.
Senate Bill 663, with bipartisan co-sponsorship, was introduced by Senator Cindy Rosenwald (D., Nashua) to address the challenges facing the Granite State’s nursing homes. It would do so in two ways. First, it would create a working group to study the reimbursement system and recommend changes. What happened on Jan. 1 made it clear that system is not working properly and unintentionally punishes facilities caring for those on Medicaid with the greatest medical needs. Second, SB 663 has initiated an effort to provide additional funding during this legislative session for nursing home care.
New Hampshire nursing home resident population is among the nation’s four-oldest, which is a testament to good health care and home and community-based options prior to admission. We must do all we can to protect this vulnerable population and provide stable funding to sustain their care and improve their functioning enough so that, in most cases, they can be discharged back into their communities. Senate Bill 663 is a compassionate step in the right direction.
Brendan Williams is the president & CEO of the New Hampshire Health Care Association based in Pembroke.