Joseph DeMattos Jr., President of the Health Facilities Association of Maryland
Joseph DeMattos Jr.

My heart breaks for people impacted by the historic threat of the COVID-19 pandemic. And while it may seem like it has already been an eternity, we still have a long battle with this virus ahead of us.

Those of us in our sector, along with everyone one else in the United States, are still discovering the challenges COVID-19 will throw at us, but we have already learned much.

We all know now that our healthcare capacity is a strategic national asset, that this capacity is not uniform in capability or funding, and that the states are indeed the laboratories of innovation.

The quick and decisive action of governors, like Governor Hogan (R-MD) and Governor Cuomo (D-NY), rightfully helped hospitals logistically and operationally prepare as best they could for the acute-care surge. Our nation’s governors could not have made these decisions without the funding and support of our federal government.

While there is no doubt that COVID-19 threw the government and our sector a curve ball, it is also evident the government could have collaborated and done more to help prepare our nursing homes and protect the most vulnerable members of our country. This pandemic has emphasized enormous unevenness in our national healthcare capacity, its funding and its staffing.

As CEO and president of a state post-acute care and long-term care association, I know that before COVID-19 struck, Maryland nursing homes already provided clinical care comparable to many hospitals, sans emergency departments and surgery suites.

Many of the same expert care providers can be found at both nursing homes and hospitals, including medical directors, nursing directors, attending physicians, nurses, nurse practitioners, physician assistants and therapists. Plus, nursing homes benefit from dedicated and passionate geriatric nursing assistants (GNAs).

Yet, reimbursement for nursing homes is lower and employees do not earn as much as they do in hospitals. With Medicaid as the dominant payer in nursing homes, our nursing assistants and other critical healthcare heroes are often paid not far above minimum wage.

With Medicaid as the majority payer and Medicare as the dominant rehabilitation funding source, nursing homes are the primary providers of quality care for older adults and sicker people in our country, because with the lower Medicaid reimbursement the cost of care to the government is much lower in our setting than in hospitals.

Hospitals, nursing homes and all providers across the continuum are critical and must work together to maintain healthcare capacity, especially in times of crisis. However, the truth is that the broader role and payer sources of hospitals result in their physical plant and staffing being better prepared for unprecedented crises like the COVID-19 pandemic.

We’ve learned that if nursing homes need to be physically laid out like hospitals and staffed like hospitals in order to be clinically prepared for emergencies such as COVID-19, Medicaid rates need to exponentially increase for that and to pay wages similar to those in hospitals.

In terms of other learnings, the only way we could have minimized outbreaks in our nursing homes would have been for national and state governments to have made ample testing available early on and to have prioritized testing of healthcare employees, residents and patients.

Despite our early efforts to keep the virus out, including aggressive visitation bans and infectious disease screenings, it still invaded our nursing homes, likely via unsuspecting asymptomatic carriers.

Early and widespread testing would have presented slightly different challenges, which we are now preparing to face as we hope testing becomes more readily available. Identifying asymptomatic carriers in employees will likely and rightfully reduce available staffing.

We must work together to overcome this, as I still believe to get staffers healthier and to protect vulnerable residents, it is better to know who is asymptomatic and COVID-19 positive than not to know.

Together, due in no small part to our brave frontline healthcare heroes and the historical financial backing of the federal government, we will get through this dramatic early stage of the COVID-19 pandemic and economic crisis.

But going forward, there will be tension between the financial needs of states, the federal government’s ability to continue to write massive checks, and consumer expectations on healthcare access, cost and quality.

A final critical lesson is that 2020 and 2021 may be the best time in our nation’s history to seriously consider moving our sector’s part of the state/federal Medicaid partnership to an entirely and properly federally funded safety net.

Joseph DeMattos, Jr., MA, is president and CEO of Health Facilities Association of Maryland.