Nursing home care faces many challenges nationwide. Roughly 62% of nursing home patients are on Medicaid, and most states knowingly underfund the costs of Medicaid care. As a result, the overall margin for nursing home care was only .7% in 2016, according to the latest federal report to Congress. At a time of low unemployment, this can make recruitment, and retention, seem impossible.
This makes it all the more striking that private nursing homes are outperforming those operated by the very same federal government that regulates nursing home quality. As USA TODAY‘s excellent investigation revealed, almost half of all nursing homes serving veterans through the Department of Veterans Affairs received the lowest-possible quality ranking, and more than two-thirds scored worse when it came to bedsores and preventable pain. These government facility ratings were kept a secret, while the ratings for private nursing homes are public information to allow for informed consumer choice.
We have seen such inconsistencies elsewhere. In Washington, the same state agency that sanctions private nursing homes consistently failed to maintain federal expectations in the operation of Western State Hospital, recently losing its federal funding – reportedly over $50 million a year for mental healthcare.
I point this out not to pick on government-run facilities. My state association represents one, and it provides excellent care, as do New Hampshire’s other county-run facilities. Providing care is no easy task. But my point is that occasional horror stories about private care that make for scary headlines nationwide obscure the fact that, for the most part, private nursing home care is pretty good.
Providers are doing the best they can within resources limited by governments that, based upon these news accounts, objectively have trouble doing things any better.
Obviously where there are bad actors the full weight of regulators’ authority must land upon them to protect residents. But what of all the good actors? Might we do more to help them?
Some states are doing more. In Maine, legislators overrode a gubernatorial veto and, in overwhelming bipartisanship, agreed on a bill to immediately provide funding for 10% wage increases for those providing direct care in long-term care facilities. In Massachusetts, where the legislative session has been typically never-ending, the budget conference committee report provides that “not less than $38,300,000 shall be expended to fund a rate add-on for wages, shift differentials, bonuses, benefits and related employee costs paid to direct care staff of nursing homes[.]”
In New Hampshire, in contrast, Medicaid reimbursement limits most nursing homes to offering a smaller starting salary to licensed nursing assistants – with 100 hours of training – than what toll attendants are paid. Where are our priorities?
Too often it seems long-term care providers are in a “least-favored-nation” status. For example, proposed federal regulation would deny to long-term care providers a tax deduction under the much-ballyhooed tax cuts passed by Congress, and enacted into law by President Trump, under the guise that health care services are exempt, even while artfully determining (on page 57) that “the performance of services in the field of health does not include the . . . research, testing, and manufacture and/or sales of pharmaceuticals or medical devices.” As one columnist notes, amazingly the IRS would even find that banks do not provide “financial services” and, thus, can enjoy the deduction.
At the risk of downplaying the plight of either the pharmaceutical industry, or banks, it is worth noting that the average pharmaceutical company or bank already probably enjoys a margin that exceeds .7%. For many long-term care facilities, this sort of tax consideration might mean the difference between solvency or insolvency.
Our caregivers’ voices may not be as loud as those of corporate lobbyists, but they deserve to be heard. Data shows that one-fifth of nursing assistants in nursing homes are immigrants, and over one-quarter of home health aides. Most front-line caregivers are women – 90% of nursing home nursing assistants, and 88% of home care workers. If they are raising kids as single moms, as they often are, their wages are below the poverty threshold due to government funding neglect. In the face of many challenges, dedicated workers provide quality private facility care throughout the country.
That quality, despite all odds, should be a focus of media reporting and is worthy a headline, or two, itself. And it is certainly worth more support from policymakers.
Brendan Williams is the president/CEO of the New Hampshire Health Care Association, which represents 90 long-term care facilities.