We are a reactive nation and nothing has demonstrated that more than a pandemic that has claimed the lives of over 820,000 people in the United States.
When COVID-19 first began its spread, considerable attention was paid to nursing homes, as any congregate setting, whether a long-term care facility, cruise ship, meatpacking plant, prison or college dormitory, proved fertile for viral transmission. A deadly national toll was exacerbated by policy decisions, with the nadir being New York’s deadly decision to flood its nursing homes with COVID-positive hospital discharges.
A commission was formed by the federal government to study the crisis besetting nursing homes, and in September 2020, among other things, recommended a permanent 12% increase in annual Medicaid payments (about $10,000 a bed) to increase staff salaries and buy equipment.
As this recommendation would require states to foot no less than half the bill, based upon the cost-sharing Medicaid formula, it found no traction. The 186-page report is long lost to Washington, D.C., recycling bins.
Now nursing homes, along with other providers, are beset with a staffing crisis born in no small part from COVID fatigue. Predatory staffing agencies are taking advantage, charging providers two to four times (or more) than what they pay their own staff members.
Price-gouging schemes are so overt the Federal Trade Commission must be asleep to ignore them. Consider, for example, a staffing agency demanding $178 an hour from one New Hampshire nursing home for the services of a registered nurse. Full-time, and spread over a year, that would be $370,240.
The state itself must use staffing agencies for public health functions. A marketplace of desperation pits providers against one another. This is completely unsustainable and it’s a recipe for a health care system collapse.
In December of last year, when vaccines were first administered, nursing home residents and workers were first in line along with hospital workers. However, the federal government made the fateful mistake of not promoting vaccination among health care personnel, and the public, upon vaccination becoming widely available, had taken its cue from headlines about vaccine refusal. After all, the average citizen might reason, if a hospital’s registered nurse will not get the shot, why should I?
Instead of being viewed as a miracle, COVID-19 vaccination became subject to conspiracy theories so pervasive that I now fear for the future of longstanding vaccine mandates (for example, against measles, mumps, and rubella) for schoolchildren.
In New Hampshire, we are relatively fortunate. Federal data shows over 94% of nursing home residents are vaccinated and over 91% of workers, despite a federal vaccination mandate being enjoined for our state. Curiously, our staff vaccination rate has been ahead of at least three states where vaccination is mandated. As of Dec. 12, we were third-best in the nation for the booster rate for nursing home staff and fifth-best for the resident booster rate.
A COVID-19 surge is largely killing people in the public, not facilities, the reverse of last December’s trend. Now the safest place for an elderly person to be is in a nursing home’s heavily vaccinated environment. Yet short-staffed nursing homes cannot responsibly admit new residents, including hospital discharges. This, in turn, is jamming up short-staffed hospitals.
In sum, the long-term future for long-term care is very tenuous. States are seeing nursing home closures that I fear are a harbinger of our future here. In Minnesota, the National Guard is staffing facilities.
Care for our most vulnerable citizens seems invisible to a federal government that once at least feigned concern, even though giving infinitely more assistance to unaccountable airlines like the one that abruptly canceled my holiday flight to see my son. Where is a proactive focus on nursing home care when we so urgently need it?
(Brendan Williams is the president and CEO of the New Hampshire Health Care Association.)