Elder care a delicate balance

  • Residents play a game of Uno at Charlene Manor Extended Care Facility. Staff Photo/PAUL FRANZ

Published: 3/28/2019 9:31:10 AM

Nursing homes have been the anchor of elder care, providing long-term stability to residents with medical needs, like dementia and serious chronic conditions, beyond the capacity of at-home care. Nursing homes are part of a mix that includes family members, Meals on Wheels, senior centers, assisted living, aging-in-place solutions and LifePath, formerly known as Franklin County Home Care, a nonprofit serving Franklin County plus Athol, Petersham, Royalston and Phillipston, providing intermittent and full-time care and more than 40 programs. Together, they offer a safety net of services and options.

The irony is, the more options elders have to choose among, the more stretched are nursing homes.

“It’s good that people have more and more options to age in place,” said LifePath Executive Director Barbara Bodzin. “That doesn’t mean that nursing homes don’t have a role, because they do. If you have someone who has no caregivers, for instance, they’re going to need that kind of help. Someone who has serious or complex medical needs is going to need that help.”

Like rural schools with their low enrollment, nursing homes cannot recoup their operating costs on a per-head basis. A lower occupancy rate coupled with a higher percentage of residents covered under MassHealth or Medicaid, rather than the slightly higher-paying Medicare reimbursement, is an equation that does not compute. The consequences can lead to closures such as the demise of New England Health Center in Sunderland, formerly Cozy Corner Nursing Home. “There will be additional closures,” said Health and Human Services Secretary MarylouSudders to lawmakers at a budget hearing in Needham recently. One in four homes have occupancy rates of 80 percent or less, which, she said, is “not sustainable.”

The occupancy rate at Charlene Manor Extended Care Facility in Greenfield is currently 92 percent, which is good, said Lisa Gaudet, vice president of business development and marketing at Berkshire Healthcare, the company that owns Charlene Manor. But that’s not the case statewide. “We’re $40 a day short per person, that’s $26 million a year we’re underfunded in our 15 nursing homes across the state.”

That financial crunch pinches infrastructure improvements and the ability to recruit and keep staff. “We want the best people working with our residents,” said Gaudet. “We also need to reinvest in our buildings, because they are their homes.”

State officials realize that they need to rethink nursing home rates and are working on a short-term package to stabilize nursing homes. “The state funding shortfall for nursing homes and its impact on quality staffing recruitment and retention is very real,” said Ernie Corrigan of Mass Senior Care. “This crisis requires the immediate attention of leaders from across the commonwealth to come together to ensure that the individuals who live at Massachusetts nursing facilities always receive high-quality care.”

The state’s 2020 budget includes a $25 million package to stabilize nursing homes. That’s only a Band-aid on a bigger problem, according to Gaudet, and we agree. Legislators need to increase nursing home reimbursement rates by MassHealth and Medicaid. The business model for nursing homes, like rural schools, is at the breaking point.

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