Bay State prepares for more closures

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Elizabeth Newman
Elizabeth Newman

The headline stopped me in my tracks: “Nursing home sector on verge of collapse.”

Well, I thought, that's not great news if your job is to cover the nursing home sector.

And it seemed a tad dire, especially for an industry that predicts constant disaster. So I called up the author of the piece and Friend of the Magazine Matt Salmon, member of the Massachusetts Senior Care Association board, to say “Is it really this bad in Massachusetts?”

Yep, Salmon, whose family runs five nursing homes, told me. He used a dark analogy.

“We've been warning for years that we are going off a cliff. We are now in the air,” he said. “We're in deep trouble.”

When nursing home operators in other states hear this, they may think, “Sure, things are tough all over.” But Salmon makes a pretty good case for why the situation is particularly gloomy in The Bay State, which he says has the fourth-worst funding in the nation for nursing homes. Similar to other states, Massachusetts nursing homes offset their Medicaid losses for years with sweet Medicare dollars. But today, a Medicare resident is spending under a dozen days in a facility, there are more Medicare HMOs, and utilization is down. Medicaid shortfalls, meanwhile, are at $37 a day.

“The average nursing home in Massachusetts has four days cash on hand,” Salmon said. “The majority operate in the red. We have no place else to turn.”

As it has since 2015, the industry asked for a $90 million kick in the budget specifically for wage increases, which it didn't receive. Nursing homes did manage a $35.5 million addition to the state budget this cycle for the wage increases, likely because of the state forcing minimum wage higher. But Salmon reminded me that approved funds are only for direct care staff.

“It allows a little bit of an ability to stay afloat, maybe a fifty-cent or dollar increase,” he said. “But it's not available for all of your staff; it's [only] for the lowest paid.”

While that's better than nothing — if there's any constant complaint among the industry it's an inability to pay a decent salary to certified nursing assistants, for example — Salmon points out that Massachusetts is a small state, home to high-quality medical centers. That's great if you're a patient who needs to visit a Harvard-affiliated center or University of Massachusetts. It's less swell if you're a small family nursing home trying to convince talent to work with you.

“We need to be able to compete for quality staff. When you are underfunded by $37 a day, there's nothing left,” he said.

Normally this is the time in a column where either the author or source says “All hope is not lost — providers must fight for their voices to be heard.” But this time around, Salmon, and I, are less optimistic.

“I think our state Legislature is going to ignore the problem and we are going to have more closures right when demographics show the silver tsunami,” he said. “I don't think people understand how fragile and dependent these people are. You can't come up with a scenario of home- and community-based services for the people we care for. You will have problems with access in the not-too-distant future.”

It's a grim idea: That it will only be when seniors are left without anywhere else to go that states will start funding the industry. I'm inclined to believe that's only the first step  — it will take cases where seniors left in their homes are found in horrible shape, or when enough legislators need to find a place for themselves or a loved one to live out their golden years.

But that doesn't mean the fight stops. Salmon and others will, every year, take their case to their state legislators, as will their cohorts around the country. As midterm elections approach, it may feel like there's not enough oxygen in the room to bring up Medicare and Medicaid. 

I'd argue, then, that it's even more important to not let yourselves be forgotten. Write your legislators, attend Congressional briefings, and, above all, vote.

Follow Senior Editor Elizabeth Newman @TigerELN.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.