We can probably assume no House Select Subcommittee will stage a showy hearing to examine the recent finding that the excess mortality rate was better during the COVID-19 pandemic for those with dementia in long-term care facilities as opposed to those with dementia living at home.
This is yet another fact that runs contrary to what has been conventional wisdom, as reflected by wild rhetoric from the Biden Administration, which, in an infamous “Fact Sheet” dated October 21, 2022, opened: “For far too long, nursing home residents have been victims of an industry with little accountability to keep American seniors safe and protected. COVID-19 has laid bare the challenges in America’s nursing homes, with over 200,000 residents and staff dying from COVID-19.”
Victims, really? An overlooked study, based on a vast amount of data, reported this January in Health Affairs assessed COVID-19 mortality in home and community-based settings (HCBS), and stated: “As a proportion of expected mortality, excess mortality rates for older recipients and nursing home residents were comparable.”
In fact, digging into the paywalled study (yes, I’m that kind of nerd), one finds that the excess mortality rate for “older Medicaid HCBS recipients (ages sixty-five and older)” was slightly greater than “among nursing home residents in the same age group (+31 percent versus +28 percent, respectively).” As the authors noted, reporting was required early in the pandemic on nursing home mortality – which “garnered media attention, and helped inform critical policy discussions and responses. Unfortunately, similar reporting was not required for people receiving Medicaid HCBS.”
In the opinion of the authors, this is a serious oversight, as they point out that, as of 2019 data, the portion of those receiving Medicaid long-term care nationally “in nursing homes and other institutions” was only around 21% the size of the Medicaid HCBS population.
I do not share all this information to pillory home care. My wife works in the sector, and my two nephews with disabilities benefitted from in-home care. I will leave demagogic generalizations to the Biden Administration and others with some ax to grind for political gain (though, looking at the polling, that gain is indiscernible). Instead, these studies reveal the truth that, in the face of an unprecedented virus, a beleaguered care sector did the best it could to protect care recipients, performing that vital duty as well, if not better, than another. So why is just one sector being attacked by federal policymakers?
In New Hampshire, we enjoyed an unprecedented success this past legislative session in obtaining a major investment in Medicaid long-term care funding this biennium. However, we achieved this by working in partnership with the home care sector. In fact, I called attention in newspaper op-eds to the needs of home care, noting two major providers were threatening to leave the Medicaid program unless funding significantly improved – an exit strategy that, obviously, does not exist for nursing homes.
Where some might see competition, I see interdependence. As I wrote in one op-ed, “If we think of services for those in greatest medical need as a three-legged stool — home and community-based services (HCBS), nursing home care, and hospital care — two of the legs are so wobbly as to cause the third to collapse too.” And our hospitals answered the call, agreeing to forego their own Medicaid increases so that the HCBS and nursing home care settings could receive more.
This funding influx could be the bridge that takes us from an excruciatingly difficult time to what we hope will be improved circumstances, yet New Hampshire’s success born of collaboration is in jeopardy if the Biden Administration, based on an objectively false narrative, singles out nursing home care for a crushing new regulatory burden. And, if that happens, home care and hospitals will suffer too.
Brendan Williams is the president & CEO of the New Hampshire Health Care Association.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
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