According to a March 13 congressional report, nursing homes in 2018 operated at the first net loss since 2000 – due to state Medicaid underfunding. New Hampshire easily had New England’s worst gap between Medicaid payments and nursing home care costs.

Yet, prior to the COVID-19 pandemic, New Hampshire also had the nation’s best percentage of nursing homes in “substantial compliance” with federal survey standards.

The paradox of this quality, despite underfunding, was a testament to dedicated caregivers and a collaborative relationship with the Department of Health and Human Services (DDHS), which works exceptionally well to educate providers on best practices. That exemplary work has continued throughout the pandemic.

Now we are amidst a pandemic that has taken a terrible toll in long-term care settings.

New Hampshire has the nation’s second-highest proportion of female nursing home residents, unsurprising given that over one-tenth of residents are 95 and older. Many male residents are veterans, including a dwindling number of World War II veterans. For these residents, and their loved ones, the psychological toll of isolation due to federal visitation and communal activity restrictions is unimaginable.

These residents matter. They are not expendable by virtue of age or infirmity. Most residents experienced the rationing of food, and other goods, from 1942-1945 as part of the effort to win WWII. What are we willing to sacrifice now in order to save them? Is even wearing a mask in public too much to ask?

Pandemic care costs are exorbitant. Nursing homes have taken beds offline to be able to isolate cases of COVID-19. They feed residents in their rooms due to the federal ban on communal dining. Personal protective equipment costs skyrocketed. Catholic Charities New Hampshire alone projects a loss this year of at least $1 million for its care facilities.

Staff flight has occurred. We are paying the terrible bills for government’s longstanding marginalization of nursing home staff. It is not irrational for a nursing assistant to now take unemployment benefits that, from federal enhancement alone (under the CARES Act), are equal to $15 an hour.

A long-term care worker stipend program created by Gov. Chris Sununu has been terrific, but is scheduled to expire June 30. It must continue at least as long as the federally enhanced unemployment benefits last. Weekly stipend payments of as much as $300 a week have not been equal to the $600 unemployment payments, but no stipends whatsoever would be worse.

New Hampshire is always unique, and has not provided the significant Medicaid funding increase other New England states provided.

Instead we are looking to $30 million in federal money Gov. Sununu invested in the COVID-19 Emergency Healthcare System Relief Fund for grants to all long-term care providers across the continuum of care. Those grants could make the difference between solvency and facilities closing, but must be allocated on more than a mere subsistence basis to ensure quality care amidst the extraordinary costs of this pandemic. If that happens, this unique approach will be a success story. If it doesn’t, providers here will fare much worse than providers even in a poor state like Alabama, which raised Medicaid rates by $20 a day to save nursing home care.

Facility visitation will be resuming on a limited, outdoor basis. Please be patient as facilities develop their limited visitation policies for these unprecedented times. Please understand that, until a vaccine is developed, our paramount objective must be keeping COVID-19 at bay.

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