It is customary in our society to rhetorically laud the elderly. Tom Brokaw, for example, coined the phrase “The Greatest Generation” with his 1998 book. It is equally customary in our society to neglect the elderly. Longevity carries with it a price society has been unwilling to pay.
With the COVID-19 pandemic, unpaid bills have come due. And it is our most fragile elderly population, those in nursing homes, in harm’s way.
It has been two months since the federal government banned nursing home visitation, communal dining, and group activities. These extreme measures were necessary for life safety, but perhaps isolating residents in that fashion made them further invisible to policymakers. Fantastic sums of federal money have been spent responding to this pandemic, but the average New Hampshire nursing home, the care sector most at risk from COVID-19, has seen only a trickle of federal help compared to gushers for other sectors.
Any optimism providers felt about the pandemic response has disappeared. Facility staff were excited to hear Gov. Sununu announce on April 16 a program that would provide weekly stipends of up to $300, but as of May 8 no stipends had been received. It is hard to get a new program rolling and state government, too, is overwhelmed by this pandemic. Yet days matter, and, concerned about personal risk, many staff have opted to quit and receive unemployment benefits that, thanks to the federal share alone, are effectively equal to working for $15 an hour or more.
In Rhode Island, the National Guard is assisting in the staffing of overwhelmed nursing homes. Will we reach that point here? We are weeks behind other states in two categories.
First, we have seen no Medicaid rate increase for nursing homes struggling to hold onto staff, keep residents safe and buy personal protective equipment at exorbitant prices. The other New England states have raised Medicaid rates and invested heavily in care. In Massachusetts, $260 million has been allocated for nursing home care alone since April 15. Even poor states have raised nursing home rates — $20 per resident, per day, in Alabama.
Second, through May 7 we had seen no state authorization for temporary health workers to assist frontline nursing staff in nursing homes, though a federal waiver expressly allowed this in recognition of the terrible staffing crisis the pandemic has created. At least one facility has had to rely upon local emergency medical technicians. Heroic nursing home staff members are worn out and need help. Amidst the worst unemployment since the Great Depression, facilities are hiring. They have been anxious to bring on these new staff positions, and have openings for licensed nursing staff, as well as dietary, housekeeping and maintenance workers.
Finally, prior to the pandemic, New Hampshire’s nursing homes had the nation’s best “substantial compliance” rate with federal health survey standards, despite New England’s worst gap between care costs and Medicaid payments for the 63 percent of residents on Medicaid. However, COVID-19 can turn a great facility into a scene of unspeakable tragedy, because the virus can slip in through asymptomatic staff. The loss of life already has been heartbreaking.
Accordingly, only rapid-result, testing-on-demand can address this risk for nursing home care, a risk that will only grow as other businesses “reopen” and facility staff, outside of work, encounter more carriers of the virus. If rapid-result, testing-on-demand is the standard for the White House, why isn’t it available for nursing homes?