My Turn: Long-term care facilities need federal relief

For the Monitor
Published: 8/13/2020 6:20:20 AM

Since the first COVID-19 outbreak in a nursing home in the state of Washington, those residing, and working, in long-term care settings have lived through a nightmare.

Because our long-term care population is especially elderly, New Hampshire has suffered a high proportion of its COVID-19 deaths in long-term care. Yet that is not attributable to any failure by the state or providers.

Within the state’s resources, it has sought to supply personal protective equipment to providers in need, and initiated a testing program for nursing home staff and residents that placed it among the first handful of states to do so absent any federal effort.

Academic studies are finding long-term care outbreaks are a reflection of community transmission, and very difficult to avoid. In New Hampshire, the virus has not discriminated between for-profit and nonprofit status, and has been indifferent to whether a facility is county-run or private. It can bring a “5-star” facility into crisis as quickly as it would a facility with a lesser rating.

Because the virus enters facilities through asymptomatic staff exposed to community transmission, health care providers are ardent supporters of the “Mask Up, New Hampshire” effort begun by the Common Man restaurant family and Rotary clubs.

We regard the future with dread. Based on examples elsewhere, we can expect very minimal compliance with any college or university rules requiring masks and social distancing where on-campus instruction resumes. That will be a recipe for community transmission.

Flu season begins in two months, and we shudder to imagine how flu risk will interact with COVID-19 risk. And yet, in balancing the life safety and psychosocial well-being of long-term care facility residents, we must soon figure out how to transition facility visitation indoors – currently it is no-contact and outdoors, which doesn’t work well for many residents.

Rather than significantly increase Medicaid rates, our state chose two primary responses to the stressors the pandemic has placed upon long-term care. The first response was a stipend program for those working with the state’s Medicaid clients, which ended July 31. This effort was greatly appreciated, but should be continued.

We have already seen one assisted-living facility, family-run for three decades, close due to COVID-19 staffing pressures. Because of limitations on who can enter nursing homes, providers, for example, cannot train licensed nursing assistants to replace any lost due to fears of COVID-19 exposure. The state has continued to recognize exposure risks with extra wages, but only in the context of liquor stores and cleaning Hampton Beach restrooms.

The second state response was a grant program for long-term care providers. While this effort is also appreciated, $30 million was divided among all classes of long-term care providers. In contrast, Alabama is giving out $50 million to nursing homes alone, on top of a $20 daily Medicaid rate increase running until the end of the national emergency. We should be as progressive as Alabama.

We empathize with state policymakers. Like long-term care providers – including nursing homes, which are federally regulated and yet have received far less assistance than some hugely profitable health care actors – states have been largely abandoned by the federal government in this unprecedented crisis. The funds given to New Hampshire under the CARES Act can only go so far. More federal relief is needed, and yet a partisan impasse threatens to further cripple our economy and imperil our most vulnerable citizens. When will we see any hope on the horizon?

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

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