Elizabeth Newman’s article, “Bay State Prepares for More Closures,” highlights a pressing issue facing those of us dedicated to caring for our nation’s seniors: inadequate Medicaid reimbursement rates. These funding shortfalls are making it increasingly difficult to keep the lights on, forcing nursing home and other long-term care facilities to operate under razor thin and unsustainable margins.

As Ms. Newman notes in her reporting, most nursing homes have four-days’ worth of cash reserves on hand. This impacts their ability to plan for the future of the facility, which affects the residents who live there and the staff who keep the place running. These low reimbursement rates are also responsible for our inability to compete with hospitals and physician’s offices, meaning highly-trained nurses are hard to find for our facilities. Simply put, nurses are the backbone of our industry. They are often the ones spending the most time with residents and patients, helping them dress, eat, and take their medications on time.

In my home state of Oklahoma, the Medicaid reimbursement rate is one of the lowest in the nation – $146 a day. Add in a provider tax of $11.38 a day and that number drops to $134 a day. Clearly, $134 a day does not come close to covering the cost of round-the-clock room and board, let alone meeting payroll requirements for nursing staff. By comparison, Oklahoma state legislators receive a daily per-diem $156.50 when they are in session.

This is just the tip of a very large iceberg. According to a report by the Georgetown Law Center on Poverty and Inequality, one in four Americans will be 65 or older by the year 2030; that’s almost 84 million adults requiring some form of care. While the elderly population is growing, the number of caretakers is not keeping up. By 2050, the total amount of adults receiving care is expected to grow by 84% but the total amount of caregivers is only expected to grow by 13% – a situation that will continue to worsen in the near-term if the lack of adequate funding continues.

Nursing homes provide immense value to their communities. For example, at my facility, Elmbrook Home — a skilled nursing, long-term care, and rehabilitation facility located in Ardmore — we provide rehabilitation services and around the clock skilled care in a comfortable and friendly environment. Our goal is to treat everyone like family and provide your loved ones with the highest level of quality care. But we are in an increasingly difficult situation.

How do we fix this? We need Medicaid to uphold their end of the bargain and provide better reimbursement rates and more training and investment in nursing staff. The evidence is clear: there is a huge fiscal cliff approaching and we need to plan for it now. If we do not succeed in finding answers to these problems, we run the risk of losing an industry that for years has taken care of seniors in our country. Where will they go if we are no longer here?

Every day, nursing homes and long-term care facilities are delivering quality care to seniors across America. We are committed to our work and to our patients. Families across the country are counting on us to help take care of their loved ones. We must not, and cannot, let them down.