Some of the state’s 74 long-term care centers are on the brink of collapse, administrators told key state policy makers last week.
Tom Blonski, president and CEO of Catholic Charities, said he currently projects a $1 million loss for the six nursing homes his group runs, which could climb to $5.5 million for the year.
“I am concerned about our future as an organization,” Blonski said of the Catholic residential mission for seniors, which began in 1945.
“I think there is an existential crisis that nursing homes are facing here and across this country,” said former state Health and Human Services commissioner Jeffrey Meyers, who recently joined the Stakeholders Advisory Board to the Governor’s Office for Emergency Relief and Recovery.
Meanwhile, loved ones anxiously read the headlines about COVID-19-related deaths in nursing homes.
Bette Liveston of Lisbon posted on Facebook that she sympathized with nursing home staff, including those where her mom resides.
“If they test negative today, they could test positive tomorrow so it’s difficult to know who is or is not infected when they are asymptomatic,” Liveston wrote.
“I haven’t seen my mother since Feb. 24 and I used to visit three days a week. The facility has had two cases, one nurse (travel nurse) and one resident, couple of weeks ago. Fingers crossed that there are no more.”
Stephanie Morris of Manchester, resident care director of Benchmark Senior Living at Nashua Crossings in Nashua, described the high-wire environment that nursing home staff deal with every day.
“All it takes is a staff member who is asymptomatic for the virus to transmit to a resident who has dementia and wanders. That resident who wanders touches everything around them and is in close contact of other residents,” Morris said.
“We need to remember that although these residents are in a ‘lockdown’ of sorts, we cannot always prevent them from moving around their units. This virus is spread very quickly, and although facilities are trying to prevent the spread, once the virus is in, containment is difficult.”
Sue Conner of Derry said she saw plenty while visiting her late mother.
“I just buried my mother (alone, with nine people allowed, after two years at a nursing home.) She was 100. I was there daily. I saw things; good and bad,” Conner wrote.
“So please don’t tell me about nursing homes. They are a reflection of our society’s values. WE are the problem. Be there, go there, demand better or nothing will change. Because, someday it will be us there wondering, ‘Why didn’t I do something?’’’
Patient mix matters
Brendan Williams, executive director of the New Hampshire Health Care Association, said that before COVID-19, his members operated on razor-thin margins, 1% to 3% of revenue over costs in a very good year, break-even in most.
Facilities are profitable only when they have enough residents who pay either with private insurance or Medicare.
Medicare, the federal health care insurance plan for seniors, reimburses nursing homes at a higher rate than Medicaid, the government health care program for low-income citizens.
New Hampshire’s Medicaid payments to nursing homes rank near the bottom, 45th of 50 in the most recent ranking, Blonski said.
That’s after the Legislature and Gov. Chris Sununu approved in the current state budget a 3.1% rate increase for nursing homes and other Medicaid providers.
Blonski said his nursing homes lose close to $50 a day for each resident on Medicaid.
The shortfall used to be made up by other patients, but the coronavirus has changed that.
Medicare residents typically are referrals from hospitals, and their stays can last up to 100 days after that hospitalization.
Those referrals all but went away when acute care hospitals ended non-emergency surgeries to make room for a surge of COVID-19 patients that have never materialized in much of the state.
Ground zero for deaths
Nursing homes have had few private-pay referrals this spring after becoming ground zero for COVID-19 deaths.
Roughly three-fourths of all COVID-19 related deaths in New Hampshire have occurred in long-term care.
Former U.S. Attorney and ex-state senator Tom Colantuono said he believes those numbers are inflated.
“Why don’t they honestly report only deaths ‘caused’ by COVID-19? It has been reliably reported by many sources that any sick or elderly person who is near death and who is merely suspected of having been infected with COVID-19 is counted in the COVID-19 column even if it didn’t actually cause the death,” Colantuono said on Facebook. “The reason is so the state or the hospital can get more money.”
Several nursing home workers pushed back at Colantuono’s assertion, saying they have no incentive to inflate fatality rates.
Before the pandemic, Medicare and private pay residents were typically 18% to 20% of a home’s population. Today they are closer to 5%-10%, Blonski said.
Meanwhile, nursing homes have done their own social distancing. Every positive COVID-19 resident gets moved to a special unit in the home with full, personal protection equipment (PPE) and beds kept open around that person, Blonski said.
“Our census is down 11%,” Blonski told the stakeholders board last Tuesday. “The next six months are going to be trying as we continue to work to build up our census.”
Catholic Charities did not qualify for the federal Payroll Protection Program because it is too big.
Blonski worries about keeping his staff once a $300-per-week extra stipend Sununu approved for direct care workers ends on June 30.
The stakeholders panel tentatively labeled the nursing home need for more COVID-19 relief funds a “highest priority,” above that of hospitals.
More money coming
The GOFERR Legislative Advisory Board last Monday urged Sununu to approve $20 million for nursing homes from the federal CARES Act grant.
On Friday, Sununu approved $30 million in relief for nursing homes.
“Long-term care is the frontline of this pandemic,” Williams said Friday. “We’re the hardest hit, yet ignored by the federal response. We appreciate recognition of our needs from Governor Sununu, legislators who advised the Governor’s Office for Emergency Relief and Recovery, and the Department of Health and Human Services.”
Blonski said the hard work now moves to getting the public to appreciate how nursing home leaders did all they could in response to this pandemic.
“We have a real public promotion campaign ahead of us as we get people to trust nursing homes again,” Blonski said.
Ted Goldstein posted the state should have done more to avert the patient crisis.
”The state should have been auditing and enforcing the individual infection control plans these facilities are supposed to have in place,” he wrote. “The state should have been auditing staff to see that they were practicing infection control on a routine basis. The state should have recognized that locking down a facility and not removing people when even one person tested positive was a potential death sentence for all the residents.”
But Jennifer Geraci of Rye said no one is to blame for this unforeseen tragedy.
“As a caretaker who has worked in many assisted living and nursing homes, may I say this. We care for your family because we choose to; that is, most of us do. But when something like this happens, a big brand mark is put on all of us as if we don’t care,” Geraci posted.
“I chose to take care of the elderly. The reason being, because most of them were kind generous, caring, people. They appreciated that we were there to help them, when many of their very own families had the means, but chose not to be caretakers because it would complicate their lives. I know in many cases that is not so, but I saw residents with families that only showed up on holidays.”
Meanwhile, the new normal for nursing homes will be more private rooms and a renewed focus on upgrading the system’s ailing infrastructure, Williams said.
“The wages of caregiver and staff rightfully were the priority, but capital needs have fallen by the wayside. We are going to have to as a society look at the physical plant,” Williams said. “This has been a challenge. This is something that has been neglected.”