My Turn: American Rescue Plan missed opportunity for nursing home care

For the Monitor
Published: 4/17/2021 12:00:03 PM

For nursing home care, President Biden’s American Rescue Plan represented a missed opportunity, even as it laudably provided new assistance for home and community based services (HCBS).

As described by the White House, the new law “provides critical funding for states to deploy strike teams to long-term care facilities experiencing COVID-19 outbreaks – which may impede vaccination of residents and workers[.]”

That would have been helpful months ago, but was yesterday’s news even as the bill was debated. Everyone in a long-term care facility who wanted to be vaccinated had been. Last minute Senate maneuvering secured some welcome dollars that rural nursing homes might share with all categories of rural health providers, but it’s certainly not enough to go around.

December 23, 2020 was the worst day for COVID-19 cases in New Hampshire long-term care facilities with 128 according to a state dashboard. In contrast, on April 9 there were 4 cases and these are increasingly asymptomatic.

On December 26, 2020, the seven-day average for daily long-term care facility deaths peaked at 8.1. On April 11 that seven-day average was fractional at .1 death per day. Vaccination works!

Yet the financial toll of the pandemic lingers. What would really help long-term care, with a care giving frontline that is 92% women in nursing homes and 87% women in home care, is an idea still posted on Biden’s campaign website: “[A]ll frontline workers putting their lives on the line should receive premium pay for their work. The Trump Administration should immediately work with Congress to pass a bold premium pay initiative.”

That “bold” idea was not incorporated into Biden’s own plan. Though, as a federal outlay, it would have fit under the budget reconciliation mechanism. It was an idea not dissimilar to Gov. Sununu’s long-term care workforce stipend program last year that used federal Coronavirus Aid, Relief, and Economic Security Act (CARES) funds.

Instead, the American Rescue Plan included another $14 billion for airlines which, as this frequent flier can attest, were not exactly doing customers a lot of favors pre-pandemic. This came on top of $15 billion doled out to airlines in the December relief bill signed by President Trump. At that time, airlines pledged they would not need more.

To be sure, there are very laudable elements of the American Rescue Plan. The economy needs a boost, while reasonable minds can argue as to how much, lest we have too lethargic a recovery to pre-pandemic economic levels. The American Recovery and Reinvestment Act of 2009 was too modest in scale to bring about a quick recovery from the Great Recession, and lessons were learned.

Going forward, Congress should build upon Sen. Shaheen’s recent bipartisan success to further defer “sequestration” of Medicare payments through the end of the year. While this was not a lifesaver, it was a lifeline.

Hospitals and nursing homes were spared arbitrary 2% Medicare cuts as they try to recover from pandemic losses. More federal help is needed. The proposed “infrastructure” American Jobs Plan would give another $400 billion to HCBS, yet not a nickel to nursing home care. Surely a lesson of COVID-19 is we must improve nursing home infrastructure.

At least New Hampshire can now do what the American Rescue Plan did not and employ the law’s ample state appropriation to directly assist the sector most besieged by COVID-19: long-term care.

Gov. Sununu had admirably done this before with CARES funds, and the state can innovate again. Already the New Hampshire House would provide more long-term care Medicaid funding, and that is without yet tapping into newfound federal dollars.

Those one-time federal dollars can be used to shore up the entire long-term care continuum in our aging state, especially in addressing a staffing crisis that predated the pandemic and has only worsened as licensed caregivers seek jobs in better paying Massachusetts. The need to do so is a moral imperative.


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

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