The future of nursing homes
While a governor’s multiplying scandals soak up attention in Albany, some of the business of government is still occurring. Over the past weeks, the Assembly passed a package of 16 bills covering New York’s 617 nursing homes. During this past year of COVID, more than 15,000 care-facility residents in New York died, roughly a third of the state’s toll.
Will the proposed reforms actually prevent major fatalities should another pandemic arrive? Probably not. But some of the measures could improve transparency and accountability, and address problems in New York’s nursing homes’ quality of care that existed long before COVID ever arrived.
The best bill of the bunch, which the Senate should take up and pass, is one sponsored by long-time Assembly Health Committee Chair Dick Gottfried, which would require nursing homes to spend 70% of their revenues on direct care for residents and nursing services, after Attorney General Tish James issued a report on nursing homes’ handling of COVID that highlighted how for-profit nursing homes can siphon money away from patient care for consulting and management expenses. New Jersey and Massachusetts have similar laws on the books already.
Gottfried is sponsoring another bill that would halt both the licensing of any new for-profit nursing homes and the expansion of existing ones. The legislation is a non-starter. The massive for-profit takeover of nursing homes isn’t New York-specific, it’s a national trend, driven by macroeconomic changes in health care costs and delivery. Halting the growth of for-profit facilities in New York won’t force nonprofits or government to open new facilities. Instead, it would just strain already existing resources.
Other pieces of legislation in the reform package are less far-reaching. One establishes a task force to propose changes in long-term care statewide. Another creates new anti-microbe and infection control training rules.
Another measure, creating exemptions to pandemic emergency rules that barred nursing home residents from receiving visitors, to allow for personal and compassionate care visits, is effectively pre-empted by newly-issued federal guidance. The feds now say those kinds of visits are allowed for nursing home residents, regardless of whether they’re vaccinated or not, or live someplace with high COVID rates.
Other bills like a well-intended one that attempts to raise the threshold for when nursing homes can discharge or transfer residents is meant for another crisis, which likely won’t be exactly the same as this one. Though the Legislature repealed the extraordinary emergency powers that Gov. Cuomo was granted to deal with the pandemic, if another pandemic arrived, state and local health commissioners could still wield the vast power they have long held to suspend laws if they deem it necessary to preserve public health.
Even post-pandemic, New York faces the prospect of a rapidly growing elderly population, which stood at 4.3 million people age 60 and over in late 2019, and was forecast to grow to 5.3 million by the year 2030. Ensuring a nursing home system that adequately cares for the elderly and vulnerable is a problem that is still far from being solved.