In 2016, Senate Bill 439 created a commission to study the worker shortage in long-term care. In November 2016, among other things, the commission recommended, “Medicaid reimbursement should be sufficient to pay the Medicaid share-of-cost of living wages that will assist in recruiting, and retaining, caregivers in both the facility-based and in-home care long-term care settings.”
Concurrently, then-Gov. Maggie Hassan had, by executive order, created a similar commission. In December 2016 that commission reported that “New Hampshire faces a serious challenge in meeting its citizens’ long-term care needs in both community and facility-based settings.” It noted that, “Medicaid reimbursement has been stagnant for many years, thereby suppressing wage growth.” Accordingly, it recommended that the state “raise Medicaid reimbursement rates to support wages that reflect the current and competitive wage scale for a healthy economy in New Hampshire.”
Despite these recommendations, Medicaid reimbursement continued to be largely “stagnant” for three long years, impoverishing workers in all Medicaid long-term care settings, until a rate increase for all Medicaid providers went into effect this past January. That rate increase, from the hard-fought 2019 state budget compromise, will be followed by another next month.
However welcome this new funding is, it’s only a down payment that cannot reverse years of funding neglect. It cannot restore the licenses of over one thousand New Hampshire licensed nursing assistants who left the profession over a two-year period. It has not changed the fact that New Hampshire still suffers a net loss of several thousand health care workers who cross the border each day to work in better-paying Massachusetts.
And the COVID-19 pandemic has revealed the terrible costs of not supporting our long-term care workforce. In the setting with the most COVID-19 risk, many workers are only lightly tethered to jobs they know too many policymakers do not value. Gov. Chris Sununu’s provision of weekly frontline worker stipends has been invaluable, but based on tenuous funding – federal CARES Act dollars. Thus the stipends were discontinued after July 31, only to resume in mid-November. However, they’re again scheduled to end, by Dec. 31, which is the deadline for states to spend CARES Act funds.
During the pandemic, yet another study was authorized by a New Hampshire law, HB 578. Due to Medicaid underfunding, it noted “long-term care facilities struggle to compete with the compensation being offered for unskilled retail positions.” Accordingly, it recommended that federal support for the Medicaid program should be increased.
Interestingly, an independent federal commission studying the COVID-19 pandemic in nursing homes recommended an annual funding increase of “$10,000 per resident” with half of new funding to “support improvements in staffing,” including “increasing the payment rates of frontline staff to a living wage.” Yet, for this to actually happen would require the federal government to assume more (or all) Medicaid long-term care costs – as it should.
Despite the terrible toll of COVID-19, and a staffing crisis, New Hampshire nursing home quality fell only to No. 2 in the country (after Vermont) in substantial compliance with federal health survey standards. Caregiving heroes persevere amidst unimaginable adversity. Whatever the path forward, it can’t consist of more studies as a substitute for action. It’s way past time we value the lives of those receiving long-term care and those providing it.
(Brendan Williams is the president/CEO of the New Hampshire Health Care Association.)