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The future of Md. nursing homes

demattos-jr-joseph-col-sigWe need nursing homes. Families need them. Residents need them. And our health care system needs them. But we also need to change nursing homes for the better, and we are running out of time to do it.

With less than two weeks remaining in this session of the Maryland General Assembly, now is the time for action by Gov. Larry Hogan and legislative leaders.

And, with the passage of the historic $1.9 trillion American Rescue Plan — including $3.9 billion coming directly to Maryland state government — we now have the resources to improve our nursing homes. In the wake of the coronavirus pandemic, we’ll have an opportunity to rethink, reexamine, reimagine, and restructure how we care for people in their golden years.

Most people have some experience with nursing homes. Across the nation, nursing homes are indispensable to so many families that simply cannot provide full-time quality care to their loved ones. Nursing homes provide specialized care to individuals who often have multiple chronic medical conditions such as hypertension, diabetes, congestive heart failure, and kidney disease.

In addition, nursing homes also increasingly care for people with traumatic brain injury, those who have experienced health care disparities, and others younger than the stereotypical 70- or 80-year-old nursing home resident. Even if these individuals could be safely cared for at home, the cost to Medicare and Medicaid would be much higher than the daily rates paid to nursing homes.

The fact is, if not cared for in our centers, so many of our friends, neighbors, and loved ones would otherwise be in a hospital at a much higher cost.

Hogan, House Speaker Adrienne Jones and Senate President Bill Ferguson exhibited bold bipartisan leadership by increasing Medicaid rates to nursing homes in his supplemental budget. That incremental increase will have a significant impact on continued access to quality care for Marylanders in need, and is deeply appreciated.

Long-term problems

In recent years, Hogan and the Maryland General Assembly have incrementally increased rates paid to nursing homes, other Medicaid providers, and providers in the disability community, doing better than most states.

Even so, the pandemic laid bare the chronic underfunding of Medicaid, which pays for the majority of nursing home care in our country. It also highlighted the need for nursing homes to be clinically prepared for emergencies such as COVID-19 with hospital-grade infrastructure, staff, tools, and resources.

Now, it’s time to act.

First, the Medicaid rate paid to nursing homes must be meaningfully increased over the coming years, perhaps in a new form of state and federal partnership. Unlike any other enterprise in our daily lives, nursing homes are predominantly paid for by the federal and state governments through non-negotiable Medicare and Medicaid rates that have been shortchanged for years. In addition, the government also directs nursing homes on how to spend those rates in the form of staffing requirements, ratios, and direct care hours.

Hospitals in Maryland are funded relative to the Total Cost of Care contract whereas nursing homes are paid daily rates set by Medicare and Medicaid based on census figures. These nursing home rates are typically much lower than the rates paid to hospitals. As a result, state governments rely on nursing homes to provide quality long-term and post-acute care at a lower cost.

The tragedy is nursing homes are not equipped like hospitals, especially like newer hospitals. In fact, most nursing homes in Maryland and across the nation are 40 or 50 years old.

Second, if a person can receive clinically necessary care in a safe environment at home, without family members having to abandon their daily lives and in a financially stable way, obviously they should. But the way to cut down on nursing home population is not a large-scale diversion to home care. Rather, it’s to invest in the health and wellness of people in their 40s, 50s, and 60s so as they age, they don’t need nursing home care.

Any doctor can tell you that a number of chronic conditions can be headed off early with lifestyle changes, medication, and intervention.

Finally, we need to invest in the future of Maryland nursing homes. That means investing to modernize the workforce and infrastructure of this vital contingent of our health care sector.  At a minimum, we must boost the number of private rooms.  In addition, long-term and post-acute care staff should have the opportunity to further their careers as the best and brightest in Maryland nursing homes.

Nursing homes have changed dramatically over the past two decades. From phasing out an institutional model in favor of a community approach to a focus on wellness and updated amenities that appeal to the next generation of residents, nursing homes stand ready to grow and evolve.

However, the changes yet to come will be the most impactful and important in our history.

From almost day one, COVID-19 put a spotlight on nursing homes. There were stories of heartbreak, tales of courage, grim statistics, and sobering reminders of the nature of our health care system.

This was a transformative crisis. It calls for profound change. Nursing homes are the logical place to start.

Joseph DeMattos, Jr. is president of the Health Facilities Association of Maryland, which represents skilled nursing, sub-acute facilities, assisted living programs and continuing care retirement communities.