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April 16, 2020

Nursing homes caring for COVID-19 patients on brink of catastrophe if state doesn’t act, industry leaders warn

By Keith M. Phaneuf, CT Mirror

Nursing homes caring for COVID-19 patients on brink of catastrophe if state doesn’t act, industry leaders warn.

The coronavirus pandemic has left Connecticut’s nursing homes days away from financial catastrophe, and Gov. Ned Lamont’s 10% emergency Medicaid rate hike is woefully inadequate to counter an unprecedented staffing crisis and skyrocketing protective equipment costs, industry leaders warned this week.

The letter from Connecticut’s largest nursing home associations comes even as the state struggles to launch a new plan to contain coronavirus spread among vulnerable seniors and preserve precious capacity in its hospitals.

“Our industry leaders forecast an inability to staff and resource our Connecticut nursing homes without your action this week,” Mag Morelli, president of Leading Age Connecticut, and Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities, wrote to Lamont and top administration officials Tuesday in a letter obtained by The CT Mirror.

The document was outlined Wednesday before the state’s Nursing Home Financial Advisory Committee.

“The evidence is clear and growing daily that a major financial commitment from the state is needed now to strengthen the ability of Connecticut’s nursing home sector to meet this challenge,” added Morelli and Barrett, whose associations collectively represent 175 of the state’s 213 nursing homes. “Revenue has collapsed in the wake of the disaster, and costs, especially staffing costs, have escalated like no other time in our history.” 

According to industry officials and the Department of Public Health, about half of Connecticut’s nursing homes have at least one COVID-19-positive resident. Neither the state nor the industry has disclosed how many residents at each facility have been infected.

Last week Lamont announced a joint plan with industry leaders to move infected residents into specially designated facilities. They named four locations — existing nursing homes in Sharon and Bridgeport, and vacant ones that are being reopened, in Meriden and Torrington. Officials had hoped to begin moving some of the COVID-19-positive residents this week.

And while the industry letter didn’t directly address whether that plan would come together, it raised a larger question: Would the pandemic financially overwhelm an industry caring for about 23,000 of Connecticut’s most vulnerable citizens?

“We are writing to advise you that these ongoing efforts to valiantly fight this virus and care in place for those stricken are positioned to fail unless you act with haste to implement a plan of fiscal action to prevent the collapse of the system,” Morelli and Barrett wrote, adding that nursing home residents accounted for one-third of Connecticut’s 554 coronavirus-related deaths entering Tuesday.

Lamont’s budget director, Office of Policy and Management Secretary Melissa McCaw, did not offer specifics, but said the administration is closely monitoring the nursing home situation.

“I greatly appreciate the role that our nursing homes play on the front line of care with respect to the elderly and other populations,” McCaw said. “This is not the final conversation.”

Officials with the Department of Public Health declined to comment Wednesday, but Department of Social Services spokesman David Dearborn said in a statement that the administration is “reviewing the letter and proposal.”

“Meanwhile, more than $36 million in across-the-board Medicaid payment increases are already being provided to help nursing facilities and their dedicated staff with the extraordinary costs of COVID-19,” said Dearborn.

Earlier this month, Lamont ordered a 10% rate increase for Medicaid payments made to nursing homes between April 1 and June 30. About 70% of nursing home care here is paid for with federal and state Medicaid dollars.

The rate hike translated into an $11.6 million payment to homes by April 7, with projections that by the end of June facilities would have received an extra $35.3 million.

In addition, facilities that opt to specialize in care for COVID-19-infected patients would be eligible for a $600-per-day payment for each person served, more than double the average daily rate.

But while only a handful of facilities would specialize in treating infected seniors, all homes are being overwhelmed by the pandemic, industry leaders argued. And sources say the additional funding only would cover  25% to 50% of the industry’s increased staffing and equipment costs.

“Nursing home employees are sick and exhausted,” Morelli and Barrett said. “They are calling out or resigning due to illness or justifiable fear of what coming to work could mean for their health and the health of their families. Nursing home providers, out of necessity, are paying enormous wage increases, differentials and bonuses just to maintain staff.”

“This pandemic is causing a nursing home workforce crisis never experienced before in our state,” they wrote. “This crisis threatens the very ability of our nursing homes to care for the residents.”

PPE costs are enormous
McKnight’s, an online news site specializing in long-term care issues, published an analysis earlier this month of personal protection equipment cost increases amidst the pandemic.

Mark-ups included: 215% for hand sanitizer; 267% for latex gloves; 1,513% for N95 masks; and 2,000% for disposable gowns.

And with price hikes like this, industry officials say, if more cash relief isn’t provided soon, it will be too late to keep some homes solvent.

One of the fiscal relief measures Congress enacted last month will pump $35 billion in emergency Medicaid funds into the states. And while Lamont administration officials note Connecticut hasn’t received its funding yet, members of the state’s congressional delegation and nonprofit policy think-tanks project the state’s share at $440 million.

The $35 million pledged by Lamont to nursing homes would come from this pool. And Connecticut’s hospitals, clinics, certain community-based social service agencies and other care providers also are laying claim to a portion of those funds.

“We have to make sure all of our stakeholders receive some relief,” McCaw said. “The needs are vast and we have to support the entire continuum.”

State Sen. Cathy Osten, D-Sprague, co-chairwoman of the legislature’s Appropriations Committee, called Wednesday for Connecticut to reassess pledged and anticipated funding to nursing homes and other care providers.

“We need to look at this broadly and recognize that this issue has been brought to light because of the rates that we’ve been paying for years,” Osten said. “I think there’s been a problem with [inadequate] funding for probably a decade-and-a-half now for workers who are that safety net for our most vulnerable.”

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