Brendan Williams

Nursing homes were an early epicenter of the pandemic, as they were especially vulnerable to viral respiratory transmission due to chronic state Medicaid underfunding that kept infrastructure aged and communal spaces congested. 

Many critics of private nursing homes delighted in piling on – with the nadir being policies announced with fanfare around President Biden’s State of the Union address this year.

Yet more complicated truths trickle out, without nearly the attention that was focused on private nursing homes.

New Jersey agreed to pay $53 million for failed oversight at two state-run veterans’ facilities, where, among other things, it was alleged that “staff members were barred from wearing masks before April 2020 to avoid scaring residents.”

Following that precedent, Massachusetts agreed to pay $56 million for failed oversight at the state-run Holyoke Soldiers’ Home, though it was reported that “neither state officials nor those who ran the home acknowledged any wrongdoing or apologized for the treatment of the veterans there[.]”

Hospitals are effectively self-regulated through The Joint Commission. However, in May, it was reported that the Centers for Medicare & Medicaid Services had desultorily begun focusing on COVID-19 transmission in hospitals, even if CMS, predictably, is keeping information private in a way it would never do with nursing homes, reportedly due to “fears of embarrassing hospitals[.]”

I am not pointing all this out to knock these other care settings but to put matters in context. That COVID-19 transmission has occurred in healthcare settings other than private nursing homes is unremarkable, given the contagiousness of this virus and the vulnerability of so many encountering it. But it has failed to generate the enduring focus and blame assignment associated with private nursing home care.

That care is in dire straits. In New Hampshire, we had a regional accounting firm conduct a survey, and roughly two-thirds of facilities were not admitting new residents due to staffing concerns. The average loss from patient care services alone went from $25 per patient day (PPD) in 2019 to $74.41 in 2021. Facilities in three counties had net income losses of over $100 PPD in 2021. And wage costs went up 23.7% from 2019 through 2021, counting staffing agency utilization.

What is the federal government’s response to this crisis, which we see replicated in so many other states? A net Medicare cut plus more expectations!

However heartening it is that 18 U.S. House members signed a letter to CMS urging them to spread out the Medicare cut, a recoupment of overpayments under the Patient Driven Payment Model, it pales in comparison to the 346 House members the insurance industry was able to crow had signed its annual homage to Medicare Advantage. That’s the same Medicare Advantage that routinely squeezes consumers and providers, denying 13% of valid claims according to a government report, including a significant pattern of denying needed placement in nursing homes.

Where’s the outrage on Capitol Hill about this? Wait, let me listen carefully… are those crickets I hear? Where’s a letter from 346 House members demanding justice for Medicare Advantage enrollees?

And let’s consider the new expectations the federal government has decreed for nursing home care. Portentously CMS would “encourage facilities to explore ways in which they can allow for more single occupancy rooms for residents.” I don’t know of any facility that would not “explore” such a possibility if it had the financial means, but the limitations of state Medicaid payments, put forth in State Plan Amendments CMS just rubberstamps, would not allow it. 

Beyond this empty exhortation, CMS apocalyptically hints again at new staffing expectations amidst an unprecedented labor crisis while piling on new infection control standards that would not apply to, say, the reported “15% increase in hospital onset MRSA bacteremia between 2019 and 2020 or the 24% increase in hospital central line-associated bloodstream infections over that same period.”

Why? Perhaps because any equitable infection control focus might diminish the pure joy of bashing nursing home care.

In signing Medicare and Medicaid into law, President Lyndon Johnson stated, “There are those, alone in suffering, who will now hear the sound of some approaching footsteps coming to help.” 

I sure wish those were the footsteps I hear now.

Brendan Williams is the President & 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.