President Biden’s poll numbers are in a terrible slump. And I cannot see how they have been improved by his administration’s continued flogging of nursing homes.
The latest broadside comes in reporting on the U.S. Centers for Medicare and Medicaid Services floating the idea of requiring “a minimum amount of reimbursement to actually flow to the direct care workforce versus all sorts of other things,” according to a top CMS official.
Leaving aside the fact that “all sorts of other things” includes food — with the price of meat and eggs alone up almost 14% year-over-year — and keeping the lights on, the inference behind this statement is galling. It suggests that providers, amidst an existential staffing crisis nationwide, are not committing resources to wages. And yet that flies in the face of academic research that found nursing homes have increased wages more than any other healthcare sector during the pandemic.
Where is CMS getting its information? Consider, for example, the Medicaid rate in the state of Washington. At the last calculation, 64% went to the direct care rate component. In New Hampshire, the median adjusted patient care cost component is $145.69 compared to a Medicaid rate that averages $201.64 a day.
The predations of national staffing agencies have been widely reported, and federal action on their price-gouging has been urged by almost 200 House members. Yet nothing whatsoever has been done by the Biden Administration. Instead, it communicates criticisms and ideas about nursing home care that seem untethered to reality.
Providers can be forgiven for thinking that at this terribly perilous moment, those looking to administer the coup de grâce have been empowered.
For example, while the title of an April 14 New York Times column, “Nursing Homes Are in Crisis. We Can’t Look Away Any Longer,” is correct, its author, Jay Kaspian King, looks away from the most obvious reason — government neglect. He instead quotes Betty Ferrell, one of 17 people on a committee that recently prepared a 604-page National Academies’ report, “The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff.” She then does exactly what the report urges we not do: Cherry-pick some findings in isolation.
Most baffling are Ferrell’s assertions that there is “no transparency” in how nursing homes spend Medicaid funds, ignoring rigorous cost-reporting requirements, or that a bad operator “can go across town and build another facility” — ignoring basic economics, quite apart from certificate of need laws and bed moratoriums. To falsely weaponize a thorough report in such a fashion does the report, and the struggling sector it depicts, a disservice.
King states nursing home workers are “sometimes disparagingly referred to as butt-wipers” — a horrific descriptor I have never heard in all my advocacy on their behalf — and suggests they are up against “big for-profit industries.” In fact, the report would suggest they are up against government itself, with the report floating the idea of a new federal benefit or at least “[i]ncreasing Medicaid payment rates to ensure that they are adequate to cover the cost of providing comprehensive, high-quality care to all nursing home residents[.]”
Given recent CMS misstatements about nursing home care, there is also some irony in the fact that the report, which certainly does not spare the sector from criticisms, also urges that “CMS needs to fulfill its responsibility as enshrined in existing statute to ensure the adequacy of Medicaid payment rates.” That’s a responsibility that CMS has long neglected by simply rubber-stamping Medicaid State Plan Amendments. And the report was issued before CMS announced its own proposed net decrease of $320 million in Medicare funding beginning October 1.
I am not sure what strange little audience there is for a steady diet of nursing home attacks, but COVID-19 has brought about what looks like an extinction event for my members, and they deserve better.
Brendan Williams is the president and CEO of the New Hampshire Health Care Association.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
