January isn’t just about making resolutions. State legislatures across the nation are beginning their sessions, including the Maryland General Assembly, which started on Wednesday.
In November, Maryland elected a nearly unprecedented number of new state legislators along with a second-term Republican Governor who won more votes than any gubernatorial candidate in Maryland’s history and who strives to work across the aisle.
We are fortunate that the presiding officers of the House of Delegates and the Senate are among the most tenured and experienced in the nation. Together all of these gifted and passionate leaders have the potential to be a model of bi-partisan leadership for the nation.
Recently, it was suggested that focusing on funding for home and community-based care will save money that is currently being spent caring for Marylanders with high clinical needs in skilled nursing and rehabilitation centers. I take issue with this.
With an increasingly aging population, we must adequately fund care across the entire continuum, including both home and community-based care and skilled nursing and rehabilitation center care. To be clear, the Medicaid rates for both community and nursing home care were increased by three percent in the Maryland fiscal year 2019 budget and even with that increase, the rate to nursing homes is underfunded by $31.3 million.
I’m always intrigued by the comparison of part-time government supported care at home to the 24/7 medically necessary care provided in skilled nursing and rehabilitation centers. As it is inaccurate to compare part-time home and community-based care to full-time medical care in a skilled nursing center, it is also a mistake to assume that most Marylanders currently in nursing homes would be able to receive the care they need less expensively at home.
The average Maryland skilled nursing home resident is in her eighties with multiple chronic conditions and some form of dementia. Most, if not all, would otherwise be cared for in hospitals, farther removed from family and at much higher costs.
The good news in Maryland is that because of decades of smart public policy decisions, we have outstanding care capacity in skilled nursing centers and notable quality care:
- In 2017, the Maryland Five-Star quality rating average was 4.1 stars—higher than ever before and well above the national average.
- Including registered and licensed nurses and nursing aides, as of October 2018, Maryland skilled nursing and rehabilitation centers provide an average of 4.32 nursing service hours per patient per day, significantly exceeding national and state regulatory requirements.
There is no doubt Maryland would be well served by more community care services. In fact, many innovative skilled nursing and rehabilitation centers are building that capacity. But most of the people served in this capacity will not come from nursing homes. They will come from the community with much lower medical needs than current nursing home residents.
For increased home and community-based care to truly bend the cost curve, it must be combined with public health initiatives that attack health disparities, for example, preventing people with hypertension and pre-diabetes from developing diabetes, kidney failure, or congestive heart failure.
To help Marylanders stay healthy and age in place, it will take the entire healthcare continuum. That means physicians, nurse practitioners, hospitals, skilled nursing and rehabilitation centers, home and community-based services, as well as individuals and families.
As our nation ages and healthcare dollars are stretched, quality lower-cost settings will be crucial to get Medicare beneficiaries home stronger and keep Medicaid recipients healthier.
Because of Maryland’s unique Total Cost of Care (TCOC) system, we are well positioned to create a new coordinated model of wellness for better healthcare outcomes while bending the cost curve. I envision skilled nursing centers in Maryland under the TCOC establishing clinically appropriate Emergency Department Divisions to avoid unnecessary hospital admissions, accept non-emergency direct admissions, and partner with home and community-based care for chronic care coordination.
To empower more of that future, state leaders in Maryland and across the nation have an opportunity to begin systematically and incrementally reducing the historic underfunding of rates with scheduled statutory funding going forward.
I’m optimistic that just as my Dad and Pop Pop stayed at home into their eighties and nineties, I too will age at home. But when the time comes and I need care in a skilled nursing and rehabilitation center, I want to ensure that funding for those centers is intact.
Joseph DeMattos, President and CEO of the Health Facilities Association of Maryland (HFAM) representing Maryland’s nursing home industry. He can be reached at JDeMattos@hfam.org.