A recent Washington Post op-ed by Manoj Jain, M.D. an infectious disease consultant, shed light on a healthcare sector where roughly 1.7 million people acquire infections each year, killing roughly 100,000. Perhaps two-fifths of those infections could be prevented just by proper hand-washing.
That sector is not nursing homes: It is hospitals.
This annual death toll, predating COVID-19, is not far off the number of long-term care deaths from COVID-19 in 2020. And it almost certainly was higher in 2020, as what prompted Jain to write was a patient of his who acquired, and died from, COVID-19 in his hospital.
Where is the outrage? Where are the lurid headlines?
I ask those questions because proportionality is a bedrock principle of fairness in our society. I ask them because I have read op-eds like one by E. Tammy Kim in the New York Times entitled “This Is Why Nursing Homes Failed So Badly.”
Without acknowledging Medicaid underfunding, Kim blames nursing home providers for every problem under the sun. She quotes an “expert” who claims “there are no limits on the levels of funding that nursing homes allocate to administration and profits.” Really? That claim would come as a shock to anyone familiar with any Medicaid cost-based reimbursement system that I am aware of.
In questioning whether the sector is losing money, is Kim suggesting the Medicare Payment Advisory Commission lied to Congress in its report last March? Compare a sector objectively losing money, pre-pandemic, to the fact that, according to New York Times’ reporting, an initial $5 billion in hospital relief went to twenty chains “sitting on more than $100 billion in cash.”
Kim’s prescription to improve nursing home care is more monetary fines, staffing ratios and a guarantee that nursing assistants make $20 an hour – though she proposes no additional funding for these latter two measures. For the funding that exists, she urges “strict accounting requirements and… regular audits.”
As if she were Alice falling through the looking glass, Kim conjures up a Wonderland where much of what she yearns for already is in place. To give just one example, the state of Washington, in addition to statutorily requiring annual cost reports it audits, has complete “access to the nursing facility, all financial and statistical records, and all working papers that are in support of the cost report, receivables, and resident trust funds.” That is hardly unique. Indeed, one must question if Kim is aware of the Omnibus Budget Reconciliation Act of 1987.
I write none of this to suggest that every nursing home provider puts quality first, or that all providers are blameless for tragedies unfolding during the COVID-19 pandemic. But piling onto nursing homes by armchair pundits like Kim is disproportionate enough to imply every other healthcare sector is perfect, a contention Jain disproves.
Brendan Williams is the president/CEO of the New Hampshire Health Care Association.