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The closure of nursing homes has ripples throughout the local community. Families who choose a home based on location or services may have to drive further or settle for less attractive properties. The caregiver must find a new employer. Residents have to adapt to new spaces and routines.
Pennsylvania had 695 nursing homes in 2019, but as of Aug. 30, that number had decreased to 669. The Pennsylvania Healthcare Association, which represents long-term care facilities, warns that more nursing homes could soon close or be declared bankrupt.
PHCA argues that the nursing home industry has long suffered from a lack of funding and that facilities are struggling under new state mandates that increase the amount of daily direct care nursing home residents receive. are.
“Despite recent attempts to close the Medicaid reimbursement gap, funding continues to fall short of actual medical costs due to years of underfunding, inflation, staffing requirements, and increased reliance on state Medicaid programs. ,” a representative for the organization told Spotlight PA. Email.
Pennsylvania's Medicaid program pays for nursing home care if you don't have income or assets. PHCA says states need to speed up the process of determining residents' Medicaid eligibility and that current interest rates are too low to cover actual medical costs. They also want high-performing nursing homes to be given extra funding.
Kathy Cubitt, advocacy manager at the Philadelphia-based Center for Advocacy for the Rights and Interests of the Elderly (CARIE), said Medicaid rates could be higher and eligibility should be determined more quickly. I agree that it is. But in the following conversation, edited for clarity, she said other structural issues are contributing to the closures, including gaps in training and a lack of transparency about how nursing homes use tax dollars. claims.
Spotlight PA: When a nursing home closes, how does it affect the people living in the facility?
Cubitt: Even with planned closures where things can be done more methodically, it's always a traumatic experience. However, there have been several recent closures in Pennsylvania under a state of emergency. In some cases, there were no staff on site. The state had to immediately move in and relocate all residents, which was completed within 24 hours. Therefore, it can be imagined that such a situation would be traumatic not only for the resident but also for their family. But it's always upsetting, even when moving from a poorly performing facility.
As long as nursing homes have existed, they have been closed. But we've also seen another troubling trend in private equity: buying nursing homes. These dog owners are coming in, and frankly, their business model is not conducive to quality care. This actually deprives residents, as well as the community, of good workplaces and community assets that people can go to when they need quality nursing home care. We have yet to see a positive situation with private equity owners.
What challenges are nursing home operators tackling to keep their doors open?
Well, you're looking after people who need a high level of care, whether it's for short-term rehabilitation purposes or, say, when they're discharged from the hospital. Or they care for people with multiple chronic illnesses, serious illnesses, or end-of-life conditions. Life issues that require a lot of consideration. And many people living in nursing homes have dementia or related disorders. It requires a lot of training.
And we are currently hearing that nursing homes have high turnover rates, not just among direct care workers, but also among managers and administrative staff. This is difficult because if you're chronically understaffed, it's not an attractive place to work for people.
A typical wage for a nursing home aide is between $30,000 and $40,000, according to federal data. To what extent are low salaries part of the reason these facilities struggle with staffing?
That's one of many factors. This is very difficult work. It's a very rewarding job. But people doing this work must be earning at least a living wage. And in many cases, people must rely on public benefits to make ends meet or work multiple jobs.
We have to start looking at these workers more professionally. And I think there's a lot of work that's going to be done through unions and other initiatives, like workforce development and career paths. So these are just as important as your salary.
PHCA places some of the blame for recent closures on Medicaid reimbursement, which it says is too low. Do you agree that Medicaid payments are the driving force behind some of the dysfunction in this industry?
That's a complicated question. But we need more transparency about where the money is going, especially as these private equity and other business models take over. Because owners and their shareholders make money by extracting money from care, staffing, and supplies.
Let's be honest: All providers of Medicaid services are probably under-resourced. And I think this is indicative of a larger problem in our country, which is that we don't adequately fund our entire long-term services and support system.
This summer, the number of hours of direct care nursing home residents in Pennsylvania received increased from 2.87 hours per day to 3.2 hours per day. But many nursing homes argue the new mandate is too expensive, especially if they are struggling to hire.
The hurdle is too low. This is not something to aspire to.
There is well-established research that this is too low as a minimum, which is why we wanted to raise it even higher. But it's still good to see an increase. There are some really unacceptable conditions in some nursing homes right now, so we need to have very basic standards.
I don't want to make it sound like it's all the provider's fault. We have some really good providers, but we need more. And this is not just a national issue, but also a national and… international issue. We are not the only country struggling to provide quality care.
When it comes to policy solutions, what do we need to start doing to achieve better long-term care?
I would like to see funding provided to the Pennsylvania Department of Health's Office of Long-Term Care Reform. They received federal funding this year, but no state funding, and they did a great job.
We also have collaborative long-term care learning through the Jewish Healthcare Foundation. They have done a lot of active training using the facility.
At CARIE, we have also worked with Philadelphia Regional Legal Services and other stakeholders to address racial disparities in nursing homes, and we urge more action to be taken to close these gaps. I hope. That report includes a complete list of recommendations.
But the bottom line is we need to keep working on staffing and training.
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