Overcoming Historic Funding Shortfall

Open Mike Guest Blog by Dr. Kimberly Townsend

October 25th, 2023

You are well aware of my unwavering dedication to the care of our cherished Elders who occupy a large place in my heart. Discovering an article by Dr. Kimberly Townsend, CEO of Loretto Management Company in Syracuse, NY, felt like a validation of my own feelings regarding the overwhelming challenges New York State Nursing Homes are facing as a result of the profound Medicaid funding deficit. I invite you to take a moment to read this article, as it delves into the profound impact that Medicaid has on every level of healthcare.

Our seniors deserve better, and understanding the gravity of this issue is the first step towards ensuring their well-being.

Michael E. McRae,
President & CEO, St. Ann’s Community

Can you think of something you purchase regularly that has increased in price since 2008? Inflation has hit groceries particularly hard in the past couple of years – what if I told you that your total grocery budget would be based on the cost of groceries in 2008?

Chances are you’d be discouraged and wonder how you’re going to provide for yourself and your family. I’m currently struggling with similar feelings when it comes to providing for Loretto employees and residents. Let me explain.

At the start of 2023, Medicaid in New York State was paying for care for 75 percent of the residents in our nursing homes – but at rates based on costs in 2008. In 15 years, the Medicaid rate for long-term care only increased by one percent. In that same timeframe, costs grew by 42 percent in pre-inflationary dollars. New York State entered 2023 with the lowest nursing home Medicaid rate in the country relative to revenue and expenses.

For Loretto, which serves 10,000 individuals each year, 72 percent of residents are supported by Medicaid – that translates to a shortfall of over $100 per person per day, or a $7 million shortfall each year.

New York State recently passed a budget touted to be historical in nature, with “substantial Medicaid reimbursement rate increases” that will assist in “creating a stronger health care system.” The “up to 7.5 percent increase” is appreciated and helpful, but unfortunately, it isn’t enough. This increase also comes, in part, by using funds previously appropriated to help facilities meet the minimum staffing ratios that were put in effect in 2021, in the middle of a workforce crisis.

Nursing homes in New York State have reached a critical point after 15 years of underfunding – and the trickle-down effect has significant implications for every New Yorker, not just the elderly.

• Staffing shortages – The healthcare industry is in a state of crisis. In October 2021, in New York State, a healthcare staffing emergency was declared. In addition to the national shortage of healthcare workers, nursing homes are not able to compete for a quality workforce due to their financial hardship. If nursing homes do not have the staff members necessary to care for individuals, they need to maintain a lower occupancy, which translates to beds sitting empty and lost revenue (and care in the community).
• Inaccessible healthcare – Many nursing homes in Central New York, including members of The Long Term Care Council of Central New York (LTCEC of CNY), which represents a total of 4,664 skilled nursing beds are, for the first time in their history, leaving beds vacant. Statewide over 6,700 beds are empty and unavailable because there are not enough employees to provide care. Unavailable nursing home beds have a direct impact on hospital capacity – when hospitals cannot discharge patients who need skilled nursing care, there are fewer hospital beds and longer wait times for patients who truly need hospital care.

According to McKnight’s 2023 Outlook Survey – answered by nearly 1,000 nursing home owners across the country, C-suite leaders, administrators, and nurse supervisors – Medicaid/Medicare reimbursement and staffing were among the top three non-COVID-related challenges heading into 2023. Notably, according to NIC Map Vision data, occupancy of free-standing skilled nursing facilities has not yet reached pre-COVID levels.

Some nursing homes have reached a breaking point – since 2014, a total of 86 New York nursing homes have closed, sold or consolidated, unable to keep up financially. Of those 86, nearly 20% have closed, sold, or have been listed for sale since the start of the COVID-19 pandemic. Those that remain are anticipating changes in 2023 – according to McKnight’s 2023 Outlook Survey, 40% of skilled nursing owners, executives, and administrators expect they will sell some or all of their nursing home holdings this year.

To meet the needs of older adults now, LeadingAge NY estimates the Medicaid nursing home reimbursement rate needs to increase by 20 percent – which is less than half the increase in costs we have absorbed over the past 15 years. Looking ahead, there are other opportunities we have to ensure our older adults are getting the best care.

By 2034, the number of adults 65 years of age and older will be greater than the number of children under 18 years of age for the first time ever. In an effort to ensure every American has the support needed to age with dignity and financial security, U.S. Senator Kirsten Gillibrand, a member of the Special Committee on Aging, has shared a five-point “Master Plan on Aging,”– affordable and healthy meals, affordable health care and prescription drugs, social security benefits and financial security, access to home or community-based care to age in place, and access to aging-friendly spaces and employment. Initiatives like this are essential as we look toward the future in Central New York and beyond.

I hope you’ll join me in advocating for adequate funding to care for the people of Central New York – our employees and co-workers, our parents, our grandparents, and our families. Let’s reach out to our state legislators, who have the ability to change this funding crisis, to share our concerns and the need to increase funding. You can also find more information about how to advocate for change on the Loretto website’s homepage.

As Senator Gillibrand said, “When you look at how a society cares for its older adults, it gives you insight into its values.” Let’s make sure our values in Central New York are represented as we search for solutions to caring for our aging population.