By Steve Syre
The LTSS Center is helping advocates highlight the financial threat facing nursing homes in Pennsylvania.
The Jewish Healthcare Foundation (JHF) has engaged the LeadingAge LTSS Center @UMass Boston to prepare a Case for Funding document that can help support efforts to improve Medicaid reimbursement rates for nursing homes in Pennsylvania.
NURSING HOMES AT FINANCIAL RISK
JHF warned that skilled nursing facilities (SNF) relying heavily on Medicaid financing face a serious threat to their financial viability. Over the past 15 years, SNF costs have risen by a third while Medicaid reimbursement rates have increased by only 1%. The average loss to Pennsylvania nursing homes from the Medicaid shortfall amounts to $47 per resident per day, or an average annual cost of $17,000 per resident, according to the foundation.
More than two-thirds of residents at nonprofit SNFs in Pennsylvania count Medicaid as their primary payor. A recent report from LeadingAge Pennsylvania estimated that the annual gap between Medicaid reimbursement and program expenses for SNFs across Pennsylvania is more than $631 million.
A DOCUMENT TO MAKE THE CASE
JHF is funding the LTSS Center as a neutral and trusted third party to develop a “fact-based, action-oriented” document that could be widely distributed to state legislators in Pennsylvania. The document is intended to highlight the positive impacts of having high-quality and viable nonprofit SNFs in Pennsylvania, and the economic and social impact that could result in the state if those SNFs closed.
“Nursing homes provide an essential and enduring component of the continuum of care that older adults and their families rely on, even as the array of options available at home and in the community have expanded,” said Edward Miller, an LTSS Center fellow and gerontology professor at the University of Massachusetts Boston.
“It is critical that nursing homes in Pennsylvania and other states have sufficient resources to provide high-quality care for the most vulnerable among us, an issue spotlighted by the devastating impact of the coronavirus pandemic on nursing home residents and staff, ” he said.
Miller is leading the project, along with Marc Cohen, co-director of the LTSS Center.
LOCAL ORGANIZATIONS LEADING PENNSYLVANIA EFFORT
JHF, LeadingAge Pennsylvania, and AARP Pennsylvania have been meeting with other nonprofit organizations and SNFs to determine the best way to make sure state legislators are aware of the financial crisis and are prepared to act. The nonprofits concluded it was essential to organize the facts regarding utilization, costs, and reimbursement, while including stories about how the shortfalls are already affecting older adults, the workforce, and the state’s nonprofit sector.
JHF asked the LTSS Center to help produce a document that can “make the case for maintaining/restoring the state’s responsibility to pay for the care of the frailest Pennsylvanians without financial resources.”
The foundation noted that some nonprofit SNFs may use endowments or benevolent fund resources to cover financial shortfalls. But for others, the rate of loss is unsustainable and places their viability at risk.
DIMINISHING CARE OPTIONS WITHOUT IMPROVED FUNDING
Options for Pennsylvania residents who need care now or may need it in the future will diminish as difficult decisions are made by nursing homes to reduce the availability of Medicaid beds as they balance their mission and financial viability, JHF said.
“Given the increasing need and demand for LTSS services across the continuum, underfunding one critical service component has implications for how the others are able to perform,” said Cohen. “We believe that putting forward a case built on empirical data and strong analytics will enable policymakers to see the importance of addressing the issue.
“Given similar challenges faced by providers across the states, the analysis could serve as a model for providers in other states trying to obtain the funding needed to provide high-quality care,” he said.
The Case for Funding document is expected to be ready by fall 2020. A planning group of nonprofits involved in the project will help the LTSS Center develop a communications and outreach strategy to reach key legislators and decision-makers throughout Pennsylvania.
Miller and Cohen are joined in the LTSS Center project by Molly Wylie and Elizabeth Simpson, students in the Gerontology PhD program at UMass Boston.