EDITORIAL: Out of the shadows: COVID-19 exposes sorry state of Washington's nursing homes

News Tribune (Tacoma, WA)

Apr. 12--The coronavirus that has turned our communities, country and world upside down has been most ruthless to the aged and frail among us. Long-term care facilities such as Life Care Center of Kirkland, where the state's first outbreak occurred, have been hit especially hard by a skyrocketing infection rate.

Look what's happened in Pierce County: Residents in two long-term care facilities accounted for around 11 percent of the county's COVID-19 cases as of early last week, and at least two deaths.

But this pandemic isn't the only challenge facing the elderly and their caregivers. Resources for nursing homes have shrunk dramatically over the years, putting Washington at increased risk of a shortage.

The Washington Health Care Association places blame directly on state Medicaid funding, saying the entire industry is in crisis.

The current Medicaid reimbursement rate in Washington is $216 a day for each nursing home resident, which computes to about $9 an hour.

Those dollars are expected to cover meals, laundry service, social services, medical supplies, activities and nursing care. And now, because of the coronavirus, these facilities have to implement tougher infection-control protocols.

Even before this pandemic struck, government inspectors had cited more than 60 percent of US nursing homes for at least one infection-control lapse during the past two regular inspection periods, according to a Kaiser Health News analysis.

Nearly 70 percent of patients in skilled nursing facilities rely on state Medicaid, an assistance program for low-income individuals funded by federal and state governments. But Medicaid funding hasn't kept up with inflation or Washington's increased minimum wage.

Washingtonians who worked, raised families and made communities better should be among the first protected by a social safety net. Sadly, the numbers suggest they're not. When it comes to Medicaid nursing home reimbursement, Washington is ranked near the bottom.

Private nursing home care averages about $10,000 a month. Not many can afford the prohibitive cost. And none of this bodes well for the year 2030, when all area Baby Boomers will be over age 65.

"Prepare for a silver tsunami," warns state Rep. Michelle Caldier, R-Port Orchard. She sits on the Washington House Health Care and Wellness Committee and notes that in 10 years, people over age 65 will comprise 21 percent t of the US population.

Caldier, a former dentist who provided care at long-term facilities including Life Care Center of Kirkland, describes the nursing home industry as barely hanging on. "The state has not prioritized this and a lot of legislators don't understand the stress nursing homes are under."

She's right. Lack of funding is why many Washington nursing homes have been closing at an alarming rate. Since 2017, 20 of the state's 215 nursing homes have shut their doors for good.

Rep. Eileen Cody, D-Vashon, recognizes the challenges but doesn't share Caldier's grim outlook. As chair of the Health Care committee and a veteran of many healthcare battles over her 25 years in the Legislature, Cody takes a more holistic approach.

She's pleased the Legislature passed a bill this year changing state rules around Medicaid rates; reimbursement will now be tied to inflation and rates will be recalculated annually instead of every other year.

And, yes, Cody says, a slight increase in the Medicaid rate was approved. By 2021 nursing homes will receive $250.71 per day for each Medicaid recipient. And, because of the ongoing COVID-19 outbreak, nursing homes that admit patients from acute care hospitals will receive an additional $100 a day per patient for no more than six months.

But real and lasting reform came in 2019, when the Legislature created the nation's first public Long Term Care insurance program. Beginning in 2022, all people who work in Washington will pay 0.58 percent of their income (through payroll deduction) into a trust fund that begins paying dividends in 2025.

Help with transportation, home modifications, food delivery and respite for caregivers will be available for those who meet the disability eligibility standard. Because of this program, the state's Medicaid program is projected to save $34 million in 2025 alone, and a total of nearly $4 billion by 2052.

We say the state should pour much of those savings back into nursing homes.

Kudos to the state for making it easier for people to stay in their homes and for expanding options such as adult family group homes and assisted living centers, but thousands of Washingtonians will still need the supervision and care only nursing homes can provide.

A critical lesson coming out of the COVID-19 is that too often the elderly are put away in long-term facilities and largely forgotten. Recent events have brought these older adults out of the shadows.

Now is the time for lawmakers to speak up for those whose voices have been softened by age or dementia. COVID-19 is not their only enemy; boredom and isolation are, too, which is why every nursing home in Washington should be well-staffed and equipped to handle every physical and psychosocial need. And be better prepared for future infectious outbreaks sure to come.

The silver tsunami is coming. We best not look away.

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