The recent news about the closing of four skilled nursing and rehabilitation centers in Massa-
chusetts, has unsettled those respective communities -- for good reason. The loss of these facilities will cost 639 employees their jobs, and force 318 patients and their families to scramble to find alternative nursing home care.
It’s taken for granted that when frail seniors and disabled individuals are no longer able to remain in their homes safely, they can enter a nursing facility and receive the daily care they need. And with 420 nursing homes throughout state, they can often live in their communities, or close by.
But this picture of readily available nursing facility care is changing dramatically. Since the beginning of the year,
four nursing homes have announced they are closing or have shut their doors. All reluctantly concluded that they could not maintain their high standards in the face of continued financial losses. Many other nursing homes are confronting the same grim situation, and additional facility closings and resultant access problems are inevitable.
The problem is that while Massachusetts has long been considered a national health care leader, the governor has allowed a steady erosion of funding to nursing homes. The vast majority of long-term nursing home care -- around 70 percent -- is paid for by the state’s Medicaid program and Gov. Deval Patrick’s proposed budget calls for nursing rate cuts of an additional $20 million.
This has left the state’s nursing homes with a huge Med-
icaid funding gap, the fourth worst in the country. Forced to operate on 2005 costs, the state’s nursing homes now provide an estimated $37 of uncompensated care per day per Medicaid patient -- a staggering loss of close to $1 million a year on average per facility. Since a nursing facility’s ability to invest in patient care and staff is dependent upon adequate funding, closing this gap is vital to providing quality care and attracting and maintaining a stable workforce.
The consequences of the funding gap are real. Nursing facilities care for almost 150,000 people each year -- both long-stay and short-term residents who receive post-acute rehabilitation services and then return home. For the approximately 30,000 individuals who no longer can be cared for safely in the community, nursing facilities are their home.
The funding gap also presents an economic threat. Collectively, the state’s nursing homes are the state’s second largest health care employer with more than 50,000 workers. In many communities, nursing homes are often the largest employers and taxpayers.
Unfortunately, more than half of the nursing facilities in the state currently operate with a negative margin. More simply put, over half of our nursing homes in Massachusetts lose money each year. This is not a sustainable model.
The current candidates for governor understand the importance of this issue. Recently, six candidates at a gubernatorial forum in Worcester discussed the nursing home funding crisis and how they would address it as the chief executive of the commonwealth. But the gubernatorial election is five months away, and nursing homes need help now.
In March, a bill that would stabilize the commonwealth’s nursing facilities and had 105 legislative co-sponsors was favorably recommended by the Legislature’s Joint Committee on Elder Affairs. The bill would set Medicaid reimbursement rates based on 2010 levels that more accurately reflect the cost of care, an important step toward stabilizing nursing homes.
While the future of this legislation remains uncertain, this much is clear. If Medicaid reimbursement rates remain at their current level, more nursing facilities will close, more patients will be displaced, more jobs will be lost, and families will have to travel outside their local communities for nursing home placement of their loved ones. Our state has long been considered a leader in health care. When it comes to Medicaid funding for our nursing facilities, it must lead again.
Abraham Morse is president, Massachusetts Senior Care Association.