Nursing Homes Need Support, not Blame, During the Pandemic

America’s nursing homes need help. Revenue and occupancy shortfalls have been a problem for years, but the COVID-19 pandemic suddenly introduced major challenges that hurt and killed nursing home residents, are crippling the industry, and may leave elderly patients without the help they need. And instead of helping, some states are actually blaming nursing homes for how coronavirus tore through these facilities.

The real culprit, however, is that Medicaid has become the de facto single-payer method for elderly care. And Medicaid’s reimbursement rates are only 75 percent of the cost of care, which means that nursing homes were totally unprepared for the kinds of supplies, sanitation practices, and staff training suddenly needed when the pandemic hit America’s shores.

Supporters of single-payer methods of care should pay attention to what’s happened in nursing homes. Two-thirds of nursing home care was provided through Medicaid in 2019, and that number is expected to grow. While private health insurance and Medicare can be used in some cases to pay for long-term care at nursing homes, eligibility requirements for Medicaid coverage for this need is quite broad. Even the wealthy can qualify as “poor” enough and potentially save themselves and their heirs hundreds of thousands of dollars. 

In the meantime, however, thanks to the pandemic, the financial squeeze nursing homes have been under for years has turned into disaster. By June, the number of COVID-19 deaths linked to nursing homes exceeded 40,000, but not due to negligence by facilities. Since the virus is particularly dangerous to the elderly, many of whom suffer from other health problems, nursing homes had to quickly adopt hospital-like safety measures and quarantine procedures. Those staff who remained at work were rarely qualified to provide more complex care, and there were no resources available to train them.

In the meantime, PPE was often unavailable even as the pandemic tore through nursing homes. And states like New York and New Jersey sent ill elderly into nursing homes as the pandemic broke out, killing thousands of people through no fault of hard-working staff. In fact, the intensity of outbreaks among residents correlated with the virus’ spread among the general population. Facilities that were already scrambling to train staff and implement safety protocols, even with healthy residents, found themselves overwhelmed.

By making Medicaid a popular single-payer option, federal and state governments have made it nearly impossible for nursing homes to adjust on the fly to changing medical circumstances. Nursing home costs have as much as doubled in many cases due to COVID-19 infections; supply increases, staff trainings and long hours, and sanitation procedures are the main drivers of these costs, and they came as lockdowns reduced the number of new patients who could be taken care of at homes. The lockdowns, purportedly imposed to save lives, have not only harmed patients in a number of ways but are a billions-dollar cost to nursing homes, which are now dipping into squeezed savings accounts to invest in staff and supplies. 

Rather than examine the Medicaid payment issue and policies which forced ill people into nursing homes, some lawmakers have decided to make nursing homes responsible for factors outside their control. In July, the New York state legislature voted to scale back liability protections for nursing homes. This is a mistake that sets a dangerous precedent. Nursing homes could be swamped with lawsuits from understandably upset family members of COVID-19 victims, but the politicians whose poor decisions led to unnecessary deaths would be able to wash their hands of the issue. In the end, more nursing homes would go broke, and the quality of elderly care in those states would decline.

As tragic as it sounds, the damage from the pandemic and past bad policies are done. Going forward, legislators need to make sure that nursing homes have the flexibility to make dynamic changes while still providing quality care. Medicaid’s single-payer price controls and policies aren’t the answer.

Kristin Story Held, M.D. is a board-certified ophthalmologist and ophthalmic surgeon.