Nursing homes are working hard to prevent COVID-19 outbreaks, but more funding is needed

While the impact of COVID-19 has been felt around the world, our nation’s nursing homes have felt the devastating consequences of this pandemic as deeply as anyone. Nearly half of the deaths in our state have involved nursing home residents, and we mourn those loved ones who were lost.

Many have asked why this happened and how it could have been prevented. There are numerous reasons this virus has been particularly challenging for nursing homes, including an inadequate supply of personal protective equipment, insufficient testing capacity, and staffing challenges that have long plagued our industry.

But the greatest challenge has been the unknown. We learn more about this virus and how it spreads every day. As guidance from the CDC and state and local health officials has evolved, nursing homes adapted quickly to follow their recommendations. Still, many questions remain unanswered about how to stop the virus from spreading.

Despite these challenges, fewer than 15% of North Carolina’s nursing facilities have experienced an outbreak. While that number will almost certainly grow, it is lower than the national average and a testament to the hard work of the staff and administrators working in our state’s nursing homes.

Gov. Cooper and DHHS Sec. Cohen also deserve special praise for restricting visitors to nursing homes in early March, a difficult decision that has saved countless lives.

During this pandemic, some have attempted to assign blame to our nursing homes or suggest that more could have been done to stop the virus. From the very beginning, nursing homes have done everything in our power to protect the patients, residents, and staff members in our facilities. It is irresponsible and unfair to suggest otherwise.

Let me suggest a more constructive conversation — looking at concrete ways our state can help nursing facilities better prepare against future pandemics and infectious disease outbreaks.

First, we need to increase pay for frontline caregivers who earn an average wage of $12.76/hour. This will reduce turnover, promote stronger relationships with residents, and provide stability that will strengthen the implementation of policies and procedures around infection control and other critical issues.

But it is difficult to pay higher wages when a majority of our state’s nursing homes are already losing money. And they are — the latest figures show that the median NC nursing home has an operating margin of –0.9%. Each nursing home in the state is currently spending an average of $417,000 more than they receive, every year, to care for residents enrolled in Medicaid.

We are grateful for the support shown by Gov. Cooper and the General Assembly — funding for nursing facilities has steadily increased over the past four years — but North Carolina’s Medicaid reimbursement rates remain the lowest in the Southeast.

The Medicaid system’s reimbursement methodology poses additional challenges. It encourages the placement of residents in semi-private rooms, rather than private rooms where they can be better protected from infections like COVID-19. We’ve been working on this issue with the NC Medicaid program and agree on the need to establish a new payment structure that makes private rooms more feasible. Now is the time to implement it.

Finally, we must keep lessons learned from this pandemic top of mind as we transition our state’s Medicaid program to a managed care system. This includes promoting innovative healthcare programs tailored to the specific circumstances of nursing home residents.

We appreciate the continued investments that our state’s leaders have made in nursing homes. This enables us to focus additional resources on protecting the loved ones who reside in our nursing homes — and we must never lose sight of that goal.