Commentary: NH falling short in its support of nursing home care
According to the most current AARP data, New Hampshire has the nation’s 5th-worst nursing home staffing shortage.
It’s instructive to consider how the two states ranking 6th and 7th on this unenviable list, both marginally better off than us, are addressing their own workforce crises. In Washington, it was through a 14.3% Medicaid rate increase, while in Wisconsin it was through a 23% Medicaid rate increase. In Wisconsin this was accomplished by raising the proportion of Medicaid care costs that the state pays to 91 percent.
If, as someone who pays listed prices at the gas pump or in a grocery store, you see that Wisconsin example, and wonder how states can pay less than the full cost of Medicaid care, you can thank the U.S. Centers for Medicare and Medicaid Services – which rubberstamps all state Medicaid underfunding while, paradoxically, ceaselessly piling new, unfunded regulatory expectations upon nursing homes.
Here credit goes to the Department of Health and Human Services (DHHS), which tries to stretch every inadequate dollar appropriated to it to do the best it can by nursing home residents. But more dollars are needed. We cannot continue to have nursing homes with beds, units, and wings offline, and wait lists of as many as 140 prospective residents, while hospitals are forced to “board” those who could otherwise be discharged – inflicting upon hospitals both financial loss and loss of care capacity. Nor is this fair to patients, who should not be forced to stay in a hospital any longer than necessary.
Representing nursing home care, I’m sorry to see this. Think of our system of caring for frail and vulnerable people as a three-legged stool, where people move between home and community-based settings, nursing homes, and hospitals. The nursing home leg of that stool is not only shaky, but ready to fall off. Yet providers are doing the right thing by only admitting those they feel they can provide quality care for, within their staffing limitations. Their first obligation is to their existing residents, and staffing challenges would never excuse neglect.
Our only hope is that New Hampshire, like other states, will provide American Rescue Plan Act funds as grants to facilities, just as Gov. Sununu did with Coronavirus Aid, Relief, and Economic Security Act funds, most recently last fall. We need a bridge to July 1, 2023, which is when any new Medicaid funding increase – hopefully as sizable as the ones that made it through Republican legislatures in Nebraska (17%), Pennsylvania (17.5%), and elsewhere – would become effective with the start of a new state fiscal year.
December 16 will be the last day in state government for DHHS Commissioner Lori Shibinette. New Hampshire was exceptionally well-served by her appointment by Gov. Sununu. I wish she had been able to fulfill her initial charge to tackle challenges facing long-term care, but, instead, the pandemic immediately hit, and she went into crisis control, where she acquitted herself admirably.
Early in the pandemic, Professor Nancy Koehn of the Harvard Business School wrote “that real leaders are not born; the ability to help others triumph over adversity is not written into their genetic code. They are, instead, made. They are forged in crisis.” That was the case with Commissioner Shibinette, so many others at DHHS, and those in health care responding to an unprecedented public health emergency. I am so grateful for their strength throughout these most trying of times. I wish those exhausting trials were over, but the collateral damage of this pandemic lingers, and our fight continues.
Brendan Williams is the president and CEO of the New Hampshire Health Care Association. He lives in Somersworth.
This article originally appeared on Portsmouth Herald: Commentary: NH falling short in its support of nursing home care
