Proposals threaten nursing homes
For New York state’s nursing homes, COVID -19 is just the tip of the problem.
Among the many missteps of our collective response to the pandemic, perhaps the most damaging is the politicization of the crisis that, in turn, has harmed the ability of the state’s nursing homes to chart a course through today’s COVID-19 era and beyond. The desire to cast blame threatens to divert us from pursuing a path that creates practical solutions for how best to protect and improve life for those in long-term care facilities and those who care for them daily.
To pursue real solutions, we must acknowledge the historic underinvestment in long-term care, whether in nursing homes, assisted-living facilities, or private homes. We need a genuine cooperative effort between government and long-term care facilities to find and fund solutions.
While the state’s reporting of nursing home fatalities has been revealed as deeply flawed, the issues go deeper. Working collaboratively with state health department officials, there should have been developed, years before the crisis, an emergency response plan to ensure that staff would be able to respond to a pandemic. We should have created and maintained a National Pharmaceutical Stockpile with the purchasing power to acquire personal protective equipment for congregate-care facilities. The absence of this support network left nursing homes on their own to compete in a global marketplace where availability and price were dictated by profiteers.
There must also be a recognition that Medicaid funding rates, representing the bulk of facilities’ revenue, have been cut back for years and are now significantly lower than the cost of providing care. Inexplicably, New York was the only state to cut resources for long-term care during the pandemic, while a number of states increased it.
Ironically, Albany is currently considering executive budget amendments creating crushing financial burdens on nursing homes far exceeding the current regulations that significantly cap potential profits. That would create a strong disincentive for investors to provide much-needed capital for this vital sector at a time when that is exactly what is required ahead of the next health crisis.
Another poison pill being considered by Albany would place a salary cap on executive and managerial staff, crippling a facility’s ability to recruit and retain key employees. Capable, skilled administrators are crucial to the safe and legally compliant operation of these highly regulated facilities. The reality of the competitive job market is that a salary cap would leave facilities facing an exodus of experienced senior staff and near-insurmountable difficulties in hiring seasoned replacements.
In addition, Albany would decree how Medicaid and non-medicaid revenue may be spent by a long-term care facility, micromanaging the operation of every nursing home in an industry that is already among the most heavily regulated, inspected, and examined. Under the current proposal, the state would not only cap salaries but determine how much to spend on dietary, recreation, laundry and maintenance. It essentially makes every nursing home a ward of the state. This has been tried before. It was called Willowbrook.
COVID -19 has created an opportunity to reinvent the state’s long-term care sector into a far more efficient, resilient, and capable one whose mission is to ensure that those in need receive extraordinary and compassionate care. If the current regulatory proposals proceed, we may find ourselves wondering in the near future, what — if anything — did we learn from COVID -19? That would be one more tragedy of this pandemic.