The COVID-19 pandemic – with its high mortality rate for the elderly and medically fragile – has put a sharp focus on long-term care.
That focus should have always existed. But public policy is so much better at being reactive than proactive.
Prior to the pandemic, the good news in New Hampshire was that a collaborative relationship between providers and the Department of Health and Human Services had paid off. We have the nation’s highest percentage of nursing homes in substantial compliance with federal health survey standards.
This spirit of collaboration will well serve the interests of resident safety in the days, weeks and months to come, despite the hardships imposed upon residents, and families, by visitation bans, communal dining and group activity restrictions, and other infection control protocols. Every reasonable effort is being made to minimize risk for our most vulnerable, though infections are inevitable.
During these difficult times, please reach out to your loved ones receiving facility-based care. Send them emails, letters and “virtually” visit with them via means like Skype or FaceTime. Try to allay their fears, and feelings of loneliness, with your love.
Going forward, we have systemic challenges. The care for roughly 63% of all nursing home residents is inadequately funded by Medicaid. In its annual report to Congress this month, the federal Medicare Payment Advisory Commission (MedPAC) found that “the aggregate total margin for nursing homes” nationally was minus-0.3%.
The MedPAC report noted the obvious, which is that “the overall financial performance of this setting is heavily influenced by state policies regarding the level of Medicaid payments.” Most states, like New Hampshire, fail to pay care costs. Even before the pandemic, was it reasonable to expect a care sector to operate at a loss?
Now facilities are leaving beds empty in the event that residents present with COVID-19 symptoms and need isolation, which is further financially devastating. They’re rationing cleaning supplies and personal protective equipment as best as they can, but these essential supplies are rapidly running out due to hoarding and the supply chain breakdown (for example, Chinese production can no longer be relied upon).
One facility informs me its maintenance staff is making face shields for the nursing staff.
Well prior to the pandemic, the consequences of Medicaid underfunding were dire for staff providing nursing home care. Underfunding depresses wages, and this can force those caring for the poor into poverty themselves. New Hampshire had seen a net loss of licensed nursing assistants prior to the pandemic.
Nationally, 92% of nursing assistants in nursing homes are women, according to the Paraprofessional Health Institute data. And 45% are 34 or younger, the age group most likely to have kids in school. Many of these women are single moms.
These caregivers are now on the very frontline of caring for those most at risk in this pandemic. And yet school closures are adding to the anxiety of many of them, who may have to make the choice between not working, and staying at home with their kids, or leaving their children unsupervised.
We are working with the state to provide childcare options, as Minnesota did when Gov. Tim Walz declared that during school closures “schools are directed to provide care to, at a minimum, district-enrolled students aged 12 and under who are children of emergency workers.” He defined emergency workers to include long-term care staff, along with other health care providers and first responders.
New Hampshire, particularly with the nation’s second-oldest population, must take all actions it can to relieve burdens upon those we depend upon to safeguard our elderly and those with disabilities.
The bipartisan Families First Coronavirus Response Act, just signed into law last week, provides additional Medicaid money to the states, and that lifeline is desperately needed by all long-term care sectors incurring unexpected costs.
(Brendan Williams is the president and CEO of the New Hampshire Health Care Association.)