From COVID-19’s first arrival in the country it was clear that its spread most imperiled older Americans and that within that group those in nursing homes and other long-term care settings were even more at risk. That has sadly proved to be true. The sickness and death at those facilities have taken a devastating toll on the nation’s most vulnerable while also severely strapping their staff and other resources to provide ongoing care to their residents.
Here in New Hampshire, the divide between COVID-19 statistics in nursing homes and the general population has been particularly striking. New Hampshire has fared far better in managing the pandemic’s spread — particularly since the summer and even during the latest surge — than many other parts of the country through a combination of effective state and local governmental efforts and, perhaps, a greater commitment by its residents to wearing masks and observing social-distancing precautions that have proven so effective.
The statistics in long-term care facilities, however, tell a different and very concerning story. According to data tracked by the nonprofit Kaiser Family Foundation and most recently updated last week, New Hampshire has the worst COVID-19 statistics of any state for cases in such facilities as a share of total cases, and also for deaths in long-term care facilities as a share of total state deaths. As for share of COVID-19 cases in long-term care facilities, New Hampshire’s 13 percent is more than double the national average of 6 percent. In the case of deaths, an eye-popping 77 percent of the New Hampshire’s total COVID-19 deaths have occurred in the state’s long-term care facilities, again more than double the national average of 38 percent.
Statistics being statistics, there are factors that might cause New Hampshire’s data to look comparatively worse. For example, the state ranks relatively lower in overall cases and deaths per million population, which would tend to accentuate the comparative percentages in long-term care facilities. Also, New Hampshire’s population is comparatively older, so nursing home numbers might be expected to be higher.
Even so, New Hampshire’s statistics ought to be taken seriously to ensure they don’t point to fundamental problems with the state’s oversight of nursing homes and other long-term care facilities. True, the numbers relate to only the coronavirus outbreak and perhaps might for that reason be dismissed as not pointing to ongoing systemic issues. But the better approach would be to assess whether the pandemic has brought into relief a need for changes.
That’s the idea behind a bill filed by Rep. Donovan Fenton, D-Keene, co-sponsored with Rep. Joe Alexander, R-Goffstown. The bill simply proposes the Legislature create a committee to study appointing an inspector general for the state’s nursing homes and to report its recommendations by Nov. 1. Currently, state oversight of nursing homes falls under the Department of Health and Human Services. In proposing the study, Fenton told N.H. Public Radio the pandemic’s impact on nursing homes led him to question whether oversight should be “branched off into its own category with an inspector general for accountability of our current systems, regulation and inspection.”
We agree it’s time for a thorough study. Such an examination could point to the need for the more independent oversight of an inspector general, but it might result in reaffirming that the state’s current approach works well or needs adjusting in other ways.
There’s no question that New Hampshire’s long-term care facilities statistics during the pandemic should serve as a wake-up call. Just Monday, a coalition including N.H. Legal Assistance, the AARP Foundation and others sued the state in federal court alleging a failure to properly administer its Medicaid waiver to help qualified older people and those with disabilities continue living in their homes and avoid nursing facility placements. In announcing the action, the coalition cited New Hampshire’s stark COVID-19 long-term care facility statistics as a heightened concern leading to its lawsuit.
Whether establishing an inspector general for nursing homes ultimately is the right answer, the Legislature should act on Fenton’s bill and start asking the questions.