EDITORIAL: Report sounds alarm on the need for new approaches to nursing homes

Apr. 17—There is widespread agreement that the nursing home industry must be reformed, if not reinvented, in order to give residents a consistently high standard of care.

A report released this month by the National Academies of Sciences, Engineering, and Medicine made a series of bold recommendations for changing the industry. Some of the suggestions are practical, others more pie-in-the-sky, but few of them will come to reality unless government officials summon the will and the funding to effect real change.

The authors' most ambitious proposal is creating a new national long-term care system outside of Medicaid, which in New York covers nearly 75% of nursing home care. New York State's reimbursement rate for long-term care facilities has been stagnant in recent years; its daily rate falls $55 short of what it costs nursing homes to care for each patient, according to Stephen Hanse, president and CEO of the New York State Health Facilities Association.

The health bill passed as part of the state budget last week will enact a 1% increase in state Medicaid rates, which the industry says is not enough.

Long-term care providers say more federal funding is needed to accomplish any meaningful improvements in how they do business.

"What we cannot support are unfunded mandates," said a statement from the American Health Care Association, a lobbying group for nursing home operators.

The operators in New York State are squirming under the new "safe staffing" law, which took effect on April 1. It requires facilities to provide 3.5 hours of nursing care per resident per day.

We did not support the law, which we saw as an overly broad brush that would hamper well-run care facilities and restrict their ability to innovate. A better approach would have patterned itself on the state receivership program that focuses on under-performing schools.

Nursing home owners make a convincing case that staffing shortages from the height of the pandemic still persist today, making the new law nearly impossible for them to accommodate.

Kaiser Family Foundation tracked state-by-state data on nursing home staffing for the week ending March 20. Of 570 facilities reporting in New York State, 29% had staffing shortages, 27% shortages of nursing in particular.

LeadingAge, a nursing home trade association, says more than 12,000 new nurses and aides are needed in New York to meet the new requirements.

James W. Clyne Jr., president and CEO of LeadingAge New York, said the mandate "will only drain nursing homes of the very resources they need to recruit and retain more staff, by forcing them to pay heavy penalties due to conditions beyond their control."

The facility operators say more federal and state funding would allow them to raise wages in order to attract new workers.

The Empire Center, a fiscally conservative think tank based in Albany, released a report this month questioning whether staffing mandates would correlate with better care. The center's analysis of state and federal nursing home data for the past two years showed that increased nursing home staffing was not associated with better health outcomes related to Covid-19 mortality.

Nearly 170,000 nursing home residents across the United States are estimated to have died from Covid-19.

The National Academies report also called for fortifying emergency preparedness before future waves of Covid strike, and for developing innovative approaches such as small-home models of care to improve residents' quality of life.

When lawmakers at the federal and state levels decide on annual funding, there are countless competing programs and special interests raising their hands. Meanwhile, the coronavirus pandemic has raised the curtain on the struggles of many residents of long-term care facilities. The isolation of people living in nursing homes can make them all too easy to forget. Politicians in Albany, Washington and elsewhere need to ensure that does not happen.

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