Lives depend on it.
The elderly population in Massachusetts is growing faster than any other population. The US Census Bureau estimates that, by 2030, those 65 and older will account for 25 percent of the state’s residents.
Not surprisingly, most people want to stay in their homes as long as possible and, because of recent policy initiatives, Massachusetts is fortunate to have a robust network of home- and community-based providers so that elders can do just that. But a study by the Executive Office of Health and Human Services found that this policy has increased home health costs by 41 percent in 2015 alone and by 85 percent since 2013. That shouldn’t be a big surprise, and we shouldn’t feign “Casablanca”-like shock when the exact outcome for which the policy was designed — more seniors at home, thus more costs — actually comes to fruition.
So it becomes a question of financial viability, and that’s where our state’s nursing homes come into the picture. Despite being the only solution for tens of thousands of families, they haven’t seen the same investment from the state.
Without question, oversight of nursing homes in Massachusetts is an important element in protecting the frail elders who live in them. After all, they are our parents and grandparents, our friends and neighbors, whose complex conditions make it impossible for them to be cared for in their homes.
What has made Massachusetts different for generations is that a majority of our providers have been either family owned and operated or nonprofits. With our names on the door, or volunteer board leadership to govern us, we have held ourselves to the highest standards of care, behavior, and financial responsibility.
The real story of the nursing home oversight issue and the troubles highlighted in recent Globe articles about an out-of-state owner is not that oversight is lacking, or that nursing homes in Massachusetts have poor quality. In fact, our skilled nursing facilities have been recognized as national leaders in quality of care, and our state’s providers achieve perfect scores in public health surveys at a rate two and a half times the national average. We strive to be perfect and the regulatory system requires us to report everything that happens, and invites oversight, including remedy and, if applicable, penalty.
The real story is that over the last decade Massachusetts Medicaid reimbursement of nursing homes has been stagnant, resulting in our Commonwealth having the dubious position of being the fourth worst state nationally in under-funding skilled services. For the two-thirds of residents in a nursing home in Massachusetts who are paid for by Medicaid, the state pays $37 per day below cost, at a rate of only $8 per hour of care.
The math doesn’t work, and providers are under pressure to cost-shift simply to stay solvent. Nursing home margins as a whole are barely above zero, and, without improvement, many will close just at the time when the aging baby-boomer demographics will swamp the system. A decade of public policy that stifled reimbursement at the expense of other budget priorities has created a situation in which inexperienced operators are bound to fail, and in which our neediest and most deserving residents become unintended victims of a losing hand at the budget poker table.
The other residents who suffer are the compassionate nursing home staff — the certified nursing assistants (CNAs), nurses, therapists, and dietary and facilities staff — all of whose livelihoods depend on fiscal stability and on this misguided public policy. For example, CNAs in Massachusetts nursing homes average $13.36 per hour, and the starting rate is only $11. These pay rates are exactly aligned with Medicaid reimbursement, and because nursing homes have been underfunded, staff wages are flat, and, in real dollars, declining.
Fortunately, there is a solution, since a Quality Jobs Initiative is making its way through the Legislature and will be front and center in the upcoming budget deliberations. The Baker administration helped to start the discussion with modest support for higher nursing home rates in its budget, but Massachusetts nursing homes need stabilization, and a long-term reimbursement strategy that must start now.
Enhanced collaborative regulatory oversight is part of the stabilization, and making sure that qualified, experienced operators are encouraged and incentivized to provide skilled nursing services is one piece of the plan. But to ignore the economic realities is foolish. Policy makers need to look at the whole picture. It is not only our frail elders whose lives depend on it, but the dedicated, compassionate staff members who provide their care.
Richard Bane is president of BaneCare, past president of the Massachusetts Senior Care Association, and was the operator of a locally owned family nursing home for 33 years.