Although President Biden, once the darling of the credit card industry and now reborn as an economic populist, has never said anything positive about nursing homes, he has inferred that nonprofit facilities can easily meet the unfunded staffing mandate his administration has proposed.

The naivete of the president’s view is obvious.  Consider a recent report that residents desperate to save their half-century-old nonprofit nursing home in East Providence, RI, held a bake sale to raise $2,000 toward the facility’s $100,000 monthly losses from inadequate Medicaid reimbursement.  That’s consistent with national trends. 

According to the Medicare Payment Advisory Committee, the all-payer margin for freestanding nursing homes fell to a negative 1.4% nationally in 2022, a dismal performance MedPAC noted “is heavily influenced by states’ Medicaid nursing home rates.”  Years ago, a now-retired provider friend of mine was fond of quipping that all nursing homes are nonprofit.  That is even truer today.

One of my members, Maplewood Nursing Home in Westmoreland, NH, belies the Biden Administration’s “Don’t worry, be happy” messaging about the impact of its staffing mandate.

The facility is owned and operated by Cheshire County.  As was true for other New Hampshire county-owned nursing homes, the facility began as an almshouse on the county poor farm in 1866.  Until recently, Cheshire County’s farm had still been providing food for its nursing home.

The county poor farms were authorized by the legislature in 1828, and I have walked among the 710 numbered graves on the farm for our most populous county, Hillsborough.  The records for those buried there vanished long ago, though we know this paupers’ graveyard includes Civil War veterans.  Their obscurity speaks to a benign policymaker neglect that persists today when it comes to our most vulnerable.

Like the Hillsborough County Nursing Home, which has had a waitlist of over one hundred prospective residents, Maplewood is beset by the workforce realignment and costs that the COVID-19 pandemic unleashed.  It is not operating 50 of its 150 nursing home beds due to staffing, despite having a waitlist of 77 prospective residents, last I checked.  It is an attractive facility too, recently renovated by county taxpayers at a cost of $36 million to, among other things, make 70% of its rooms single occupancy with private bathrooms.

The Biden Administration’s mandate proposal would assume that the appetite of Cheshire County taxpayers for subsidizing their nursing home’s operating losses is inexhaustible.  To meet the staffing ratio, it would have to cease operating more beds, leaving it but a shell of its former self and likely completely unviable.

A licensed nursing assistant (LNA) at Maplewood makes no less than $18.51 an hour, plus excellent union-negotiated benefits, with a $2,000 sign-on bonus for full-time employment.  Yet, with 45 full-time LNA positions open at my last check, the facility must use staffing agencies at a cost of as much as $52 an hour for an LNA’s services.  It had 43% of its full-time licensed practical nurse positions open, and 70% of its full-time floor registered nurse positions open.

Due to a lack of nursing home access, the Cheshire Medical Center, the local hospital, has reportedly been jammed up with discharge-ready patients, for which it “no longer receives any payments from insurers or government payers, meaning Cheshire Medical absorbs those costs.”  On December 21 Maplewood was finally able to admit someone who had been in the hospital since February.

As a senator, President Biden reportedly sided with his son, a credit card lobbyist, and opposed “strengthening protections for people forced into bankruptcy who have large medical debts” – making his born-again advocacy for the medically vulnerable suspicious.  Even his own U.S. Small Business Administration has questioned the efficacy of his staffing mandate proposal, citing the example of the nonprofit Maine Veterans’ Homes already reeling from staffing agency predation.

That Biden’s anti-nursing home crusade might even take down excellent nonprofit facilities like Maplewood, while further engorging staffing agency profits, reveals the emptiness of his vision for long-term care.

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.

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