Recent Eagle investigations have laid bare the steep challenges facing the county’s nursing homes and the resultant struggles for those who depend on them. The gravity of this crisis is borne out not only in alarming statistics but in heart-rending stories of suffering endured by nursing home residents and their families.
The Eagle found that, from January through October 2021, half of Berkshire nursing homes’s average staffing levels did not meet state requirements put in place last year, while more than two-thirds don’t meet minimum staffing levels recommended by the Centers for Medicare and Medicaid Services. Behind these numbers are people trapped in a hellish world and those left to helplessly look on while trying to do their best by their elderly loved ones who need care.
One person spoke to The Eagle about visiting her father at a Pittsfield nursing home, where she said he is regularly left lying in his own waste for hours: “One time I went into his room, and from his wrist down into his fingernails he was covered with [feces].” A Lee woman, after reading The Eagle’s initial report, wrote a letter to the editor explaining that she had to place a loved one in a facility after caring for him at home became untenable due to her own health issues. She wrote that he is “neglected daily,” and while she previously was able to visit and assist in his care, COVID has made that impossible. She concluded her letter: “I spend part of every day in tears.”
Sadly, these stories are not unique. We should find them unacceptable. Nursing home staffing issues have been pressurized by the pandemic, but the issue isn’t new. A graying population — particularly in older, underserved and less-populated areas like Berkshire County — means it won’t be letting up anytime soon, COVID or not.
Fixing Massachusetts' nursing homes is a complex problem; here are some of the ways lawmakers are trying to do it
EAGLE INVESTIGATION: As state lawmakers pursue nursing home reform, better wages for workers, improved reimbursements for nursing facilities and increased support for alternatives to nursing care are all on the table.
Advocates and officials alike have offered potential solutions, though the systemic nature of the problem suggests no simple solution. A legislative proposal (S.414, H.727) from state Sen. Patricia Jehlen, D-Somerville, and state Rep. Ruth Balser, D-Newton, could offer a good start. It would require Massachusetts nursing homes to meet the minimum staffing recommendations set by CMS — 4.1 hours of care and 0.75 registered nurse hours per resident per day — as well as start a “career ladder” program, a wise approach to curbing employee -retention issues facing many of these facilities.
The bill would also require facilities to adopt outbreak response and social isolation prevention policies, a serious shortcoming across the industry exposed by the novel coronavirus.
Nursing home owners blame Medicaid shortfalls for staffing struggles. Critics say they're being cheap for profit
EAGLE INVESTIGATIONS: The people who run Berkshire County's nursing homes agree with their critics that workers need better wages — and the buildings need more staff — to provide a higher quality of care. They disagree on how to achieve this.
Still, even this legislation’s sponsors stress that this or any approach must be accompanied by a clear-eyed realization of the broader obstacles to progress. About three-quarters of long-term care residents are on MassHealth, the state’s Medicaid program. The gap between that program’s reimbursement and care costs is between $25 and $30 per patient per day. Add that up for an entire facility over a year, and the dire math is a stark indication of just how much Medicaid, upon which countless seniors rely, is falling short of covering the true cost of care. On the workers’ side, industry leaders and advocates agree that compensation for critical roles like nursing assistants is simply not where it needs to be in most places to compete for and retain the necessary workforce.
Meanwhile, oversight mechanisms appear ill-equipped in the face of these challenges. A professor who has analyzed the nursing home industry for four decades told The Eagle that CMS doesn’t do a thorough enough job of enforcing its own requirements and recommendations, noting that the federal offices “only audit about 1,800 nursing homes out of 16,000.” It’s not much better at the state level. In recent years, audits of the Department of Public Health and the Executive Office of Elder Affairs cited significant issues with those agencies’ complaint and abuse investigation practices.
To be sure, there are some creative and innovative solutions that can make progress on the margins of this issue, which could be pursued by a blue-ribbon committee of industry leaders, advocates, officials and other stakeholders who might put their heads together on this matter. What it largely comes down to, however, is what it always does for big social problems: Are we as a society willing to allocate enough money to provide adequate care for our seniors?
This is by no means a cheap problem to tackle, but the moral cost of abdication is far higher. That was realized decades ago when one of the nation’s most enduring and politically popular programs was born: Social Security. Ensuring dignity and quality of life for seniors was and is an affirmation that societies are measured by how they treat their most vulnerable citizens — especially the elderly. If this nursing home investigation is any indication, we are failing that test, but it needn’t be so.
Beacon Hill leaders should prioritize measures that not only require nursing homes in underserved areas to meet appropriate staffing levels but boost funding to that end. At the federal level, our representatives in Congress should improve regulatory oversight while taking a hard look at our nation’s budget and ask if we as a country invest enough in elder care given the outsize need and the harrowing scenes playing out in far too many facilities.
We must have the political and economic courage to stare down this crisis gripping so many of our seniors and their families — and pursue the necessary investments to do something about it.