Decline in admissions, staffing imperils state nursing homes

ALBANY — New York’s long term care facilities have found themselves with acute staffing shortages while facing a sharp drop in admissions as the pandemic has motivated more families to choose other options for caring for frail relatives.

Prior to the pandemic that reached New York in March 2020, the occupancy rate at New York’s more than 600 state-regulated nursing homes stood at about 93%. It is now about 72%, industry executives say.

Put another way, that means the vacancy rate has approximately tripled in 16 months.

Safe staffing

The financial situation is so dire for some homes that operators are expected to cut their losses by closing homes.

Michael Balboni, director of a trade group, the Greater New York Health Care Facilities Association, said operators have had to weather a total of 2.5% in reductions in the state’s Medicaid reimbursement rate heading into the pandemic.

Nursing homes now face an expected increase in labor costs after lawmakers approved a “safe staffing” measure that mandates nursing homes offer a minimum of 3.5 hours of direct care daily to residents.

Critics of the measure argued it will imperil facilities already left financially fragile.

But Sen. Gustavo Rivera, D-the Bronx, chairman of the Senate Health Committee, argued such a mandate is overdue.

“We have three and a half hours where actual people that are professionals — whether it’s nurses aides or licensed nurses — actually take care of individuals,” Rivera said in promoting the bill. “We believe that this is necessary.”

Pre-pandemic push

How the Legislature addressed the nursing home situation, Balboni said, was not a response to the pandemic but instead a response to a union-endorsed agenda for more staffing, a push that had begun long before the spread of the COVID-19 contagion.

While the new state budget provides $64 million to nursing homes and acute-care facilities to help with the hiring of additional staff, Balboni said the cost to the facilities from mandated staffing levels could prove to be in the billions of dollars.

Balboni said he questions whether state leaders learned any lessons at all about how nursing homes can be protected should there be another pandemic.

“We should have institutionalized the best practices that worked.” he said. “We should reimagine long-term care as well. But we are not doing any of those things.”

‘Right-sizing’ effect

The impacts to nursing homes amid the public health crisis could end up leading to a “right-sizing” of the industry if the elevated vacancy rates persist, said William Hammond, research fellow at the Empire Center for Public Policy.

Before state Attorney General Letitia James’ office documented the fact the Cuomo administration was undercounting the COVID-19 deaths of New York nursing home patients, Hammond called attention to a noted drop in occupancy at the facilities, suggesting it was an indication the facilities were dealing with more fatalities than the state had acknowledged.

“If this vacancy rate continues and we don’t need as many nursing homes as we have right now, this is not necessarily something people should freak out about,” Hammond said. “Everyone agrees nursing homes are not ideal for most people, though they are necessary for some people. Right-sizing is always the appropriate thing to do.” The goal, meanwhile, should be to support solutions that “serve the patients better.”

Some experts suggest efforts to keep the virus from seeping into nursing homes by cutting off visits to residents has helped motivate some families to keep their frail relatives in their homes or find other alternatives. Restrictions have lessened with most residents now vaccinated, though some remain in effect.

Absorbing costs

So-called sub-acute units, housing people for relatively brief stays after they have had surgeries, are beginning to experience an influx of patients as hospitals resume elective surgeries, said Stephen Hanse, the president of New York State Health Facilities Association.

But New York leads the nation in the shortfall nursing homes face from being approved for just $211 per day for Medicaid patients, while the actual cost is $266 per day.

“The nursing home is forced to absorb it,” he said, noting about 80% of the nursing home residents in New York have their stays covered by Medicaid.

‘Smacks of ageism’

Hanse said he fears some New York facilities will be forced to shut their doors.

“The way state policy speaks to nursing homes almost smacks of ageism,” he said. “The state needs to see our seniors as an investment and not an expense. “

With demographic data suggesting more and more members of the Baby Boom generation will be needing nursing home care over the next decade, Hanse said, the state should frame policies that assist operators with recruiting and retaining the workforce that will be needed.

“The state can only neglect long-term care for so long,” he said.


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