What Trump’s ‘A+’ response looks like for nursing homes

Over 40% of the nation’s COVID-19 deaths have been in nursing homes, and the Trump administration convened a Coronavirus Commission for Safety and Quality in Nursing Homes to study the challenges. Comprised of leading academics, sector and workforce representatives, and resident advocates, the commission delivered its report this month. The administration claimed complete vindication. That claim is worth closer examination.

The administration has pointed to federal relief funds provided nursing homes, without noting they comprise only 4.2% of what Congress allocated for health care provider relief. Importantly, while the commission urged “federal relief funds for hazard pay options,” not a single penny of a recent $2.5 billion distribution to the nation’s nursing homes can be used for employee retention. With workforce stipends having ended here in New Hampshire, and nursing home residents and staff at the epicenter of COVID-19 risk, staff retention is severely challenging.

The administration is also counting as relief funds what were simply advances on Medicare payments. Those advances, which must be repaid as loans, carry a 10.25% interest rate, which might make a loan shark blush given the Federal Reserve lending rate of .25 percent. Sen. Jeanne Shaheen has pushed bipartisan legislation to lower this rate.

The commission also urged the federal government to “ensure nursing home owners and administrators can procure and sustain a three-month supply of high-quality supplies of PPE.” The administration responded by pointing to a miserly two-week supply given nursing homes. The administration doesn’t acknowledge most of those federal supplies were useless, as front-page reporting in this newspaper, and elsewhere, has noted.

The commission urges more Medicaid funding equivalent to an “annual increase of $10,000 per resident (about 12% of 2016 expenditures)” to bring on new staff and, importantly, boost “the payment rates of front-line staff to a living wage.” However, the Trump administration has sought to cut its share of Medicaid participation, and states are in charge of initiating Medicaid funding increases.

Simply obtaining a 3.1% Medicaid funding increase for the current fiscal year was a chore, and New Hampshire providers fear the fate of one scheduled for Jan. 1. Furthermore, $30 million in federal funds given to the state were pledged for grants to long-term care providers, but have been disbursed haphazardly with no explanation as to denials – providers untouched by COVID-19 have received huge sums and facilities that suffered outbreaks have received denials.

It is worth noting that thanks to the excellent work of the New Hampshire Department of Health and Human Services, and its collaboration with providers and resident advocates, we were already ahead of the commission’s recommendations on testing and visitation. Still, the emotional and psychological toll of this pandemic upon residents, their loved ones, and facility staff, is utterly unimaginable.

On Fox & Friends President Trump modestly praised himself for “a phenomenal job” in tackling COVID-19 – awarding himself “an A+.” Survivors of the over 77,000 nursing home residents and staff who have died (according to the New York Times database) might feel less enthusiastic about the death toll.

The reality today remains what Sen. Maggie Hassan stated on the Senate floor in speaking in favor of a $20 billion relief package for nursing home care, which Senate Majority Leader Mitch McConnell killed: “Months into this pandemic there is still no robust federal strategy to support the residents and employees of nursing homes. That is inexcusable.”

Are our most vulnerable citizens, and the heroes who care for them, to be treated as expendable?

(Brendan Williams is the president/CEO of the New Hampshire Health Care Association.)

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