Help nursing homes help seniors

Nursing homes throughout New York went into the pandemic struggling to recruit and retain workers. Then providers lost more staff due to illness and workers staying home to care for their children when schools were closed. New York’s policymakers implemented a hospital-centric approach to combating the coronavirus by turning the Javits Center into a pop-up hospital and summoning the USS Comfort to New York Harbor, among other initiatives, all the while treating the needs of nursing homes and their residents as an afterthought.

Legislators and policymakers are well aware of New York’s long-term care workforce crisis. There have been many bills introduced in the State Legislature under the guise of "nursing home reform," including a special-interest "direct-care patient ratio" bill that would mandate that 70% of revenue the nursing homes collect be allocated to direct care, with the rest for staff wages and benefits.

This makes it hard, if not impossible, for nursing homes to complete essential projects, such as building improvements, and takes away from other services, such as food service and laundry.

This bill does not improve quality outcomes or address the two most important issues facing nursing homes in our state, namely the crisis in long-term care workforce staffing and the state’s record of slashing more than $2 billion in Medicaid funding to nursing homes over the last 12 years.

The New York State Health Facilities Association (NYSHFA) and other nursing home advocates have been raising the workforce crisis for years with both the legislature and the Department of Health. The workforce shortages are well documented in the 2020 SUNY Center for Health Workforce Studies report and the Department of Health’s 2020 minimum staffing report prepared by Cornell University. However, not a single bill introduced in the legislature or in the budget would meaningfully address New York’s long-term care workforce crisis. There are steps the state could take, for example, educating young adults in high school and state colleges about the fulfilling careers available in long-term care.

On top of New York’s nursing home workforce shortages, the state continues to significantly underfund nursing home care, and even cut almost $100 million in Medicaid funding to nursing homes in the middle of the COVID-19 pandemic.

Almost 80% of New York’s nursing home resident care is reimbursed by Medicaid. By our calculations, the average cost of providing 24-hour nursing home care in New York is $266 per resident per day, but the state only pays an average of $211 per resident per day — or $8.79 per hour. This $55 Medicaid shortfall is the largest in the nation and directly impacts a nursing home’s ability to retain nurses when hospitals can always pay them more.

If legislators and policymakers are truly sincere about nursing home reform, they will oppose arbitrary spending ratio bills and implement measures to recruit and retain workers in long-term care. Moreover, legislators and policymakers must view our seniors as an investment, not an expense, and increase Medicaid reimbursement to nursing homes. Failing to address these two issues is a failure by the state to implement true and meaningful nursing home reform.

Stephen B. Hanse is president and CEO of the New York State Health Facilities Association and the New York State Center for Assisted Living.