My Turn: State can and must do better for long-term care system

For the Monitor
Published: 3/11/2017 12:14:56 AM

As the New Hampshire House begins work on the House Bill 1, the state budget, it must decisively address a long-term care funding crisis.

According to a national study, New Hampshire – the nation’s second-oldest state – has the nation’s third-largest gap between Medicaid payments and costs for the skilled care provided by nursing homes.

A budget device currently reduces payments 27.34 percent below what the state’s own rate system dictates payment should be. The consequences can be striking: One nonprofit Concord nursing home, for example, has a rate that doesn’t even cover the nursing wages associated with each Medicaid resident’s care – falling $43.44 a day short of “patient care” costs, and only covering 52.1 percent of total costs. Supplemental payments resulting from a fee each facility pays do not erase these huge funding gaps.

When you consider that Medicaid supports over three-fifths of nursing home residents, it’s easy to see what a desperate situation this creates. Last September, a 45-year-old nonprofit nursing home in New London closed, displacing residents to other counties.

HB 1 would make chronic underfunding worse by freezing the nursing home appropriation for the next two years. This would have a devastating impact upon recruitment and retention of caregivers. As Gov. Sununu rightly noted in his budget address, “In New Hampshire, we pay toll collectors more than nursing assistants.” Why would people bother incurring the cost, and time, to acquire 100 hours of training as a licensed nursing assistant if, say, a restaurant pays as much (or more) for less-challenging work?

The state knows the difference proper funding can make. It is giving its own nurses a 15 percent wage increase, including those who care for prison inmates, at the same time it would deny additional resources for those caring for roughly 4,200 nursing home residents on Medicaid.

No one should disagree that all caregivers, including the state’s, deserve fair compensation, but the state should treat those caring for its Medicaid clients in the private sector as well as it treats its own employees. Remarkably, the most recent 15 percent increase for the state’s own nurses is over double the Medicaid increase (7.2 percent) for nursing homes over an eight-year-period.

Another big issue in the budget is whether to turn over administration of the state’s long-term care program to private “managed care organizations” by year’s end. A post-election poll found that 73 percent of voters oppose such an idea, and wisely so; in the many years since Medicaid managed care was first proposed here in New Hampshire, no one has shown how the system would be improved by diverting already-scarce care funding to huge insurers.

I think of all the veterans I know being cared for, some of whom even survived prisoner-of-war camps. They paid taxes dutifully throughout their working lives. Is it fair that their caregivers are not worth the same raise given to caregivers in prisons? And I think about the kids with profound disabilities living at the Cedarcrest Center for Children with Disabilities in Keene. Their care funding would be frozen, too. Do their futures not matter?

For too long in New Hampshire, both caregivers and those who employ them have been forced to suffer in order to balance the state’s budget. The effects can be ironic: A nonprofit organization like Catholic Charities New Hampshire, operating seven long-term care facilities, in effect finds itself providing charity to the state itself.

We can do better. Even an additional $10 million in state resources would help save a reeling long-term care system. Lawmakers must treat HB 1 as the starting point, not the finish line.

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




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