“Alice” is 87 and by most measures she has lived a good and interesting life. She worked most of her adult life, raised a family, went to church regularly and played by the rules. Today, though, she is in deteriorating health and lives in a long term care facility.
This Mother’s Day, she will enjoy her family’s company and be honored by her caregivers, most of whom are also mothers.
But beyond their shared status as mothers, what Alice and her caregivers really represent is a health care setting that is dominated by women. More than 70 percent of the 35,000 long-term nursing home residents in Massachusetts are women and they are cared for every day by a predominantly female workforce.
What also binds these women together is that they are heavily reliant on the Medicaid system, a system for the poor that is under almost constant attack and is chronically underfunded. Medicaid supports two-thirds of our residents while three-quarters of a skilled nursing facilities budget is dedicated to wages and benefits.
The influence of Medicaid funding on nursing home care wouldn’t be so dramatic if it paid for the actual cost of that care, but reimbursement rates have been frozen in Massachusetts for more than five years, leaving a funding gap of $32 a day for every resident on Medicaid. That gap now is more than $315 million and rising every day.
The public, and most certainly our residents and their families, expect high quality care in our residential settings. Every resident, whether they come to us impoverished under the Medicaid program or pay privately for their care, is entitled to the very best care that we can provide.
But the notion that you can continue to provide that care for less than what it actually costs is a fallacy that needs a reality check.
That reality check may come in the form of legislation filed this session by state Senator Harriet Chandler of Worcester to reinvest in the long-term care system in Massachusetts by bringing Medicaid reimbursement levels in line with the cost of care. The legislation would also provide grants for educational scholarships and increase wages for employees and prospective employees in order to attract and keep experienced and skilled caregivers who often leave for better paying positions.
And wouldn’t we want to stabilize this system? The demand for long-term care and short-term rehabilitative care in skilled nursing facilities will only go up as the baby boomer population continues to age. Every day in America, 10,000 people hit retirement age and Massachusetts is among the “oldest” states in the country. Is this really the system we want for our parents or, for that matter, ourselves?
What we know from experience is that when the Legislature invests in nursing home care, the quality of that care goes up, consumer satisfaction rises and deficiencies and staff turnover rates go down. When we pay good wages to our employees, they are better able to care for their own families, pay for child care, and further their education and careers. With a career ladder in front of them, they tend to stay longer at one facility and become more highly skilled caregivers to their residents.
However one feels personally about nursing homes, they are essential to the overall health care system. Our facilities are where hospital patients come after being discharged for post-acute care and rehabilitation services. We are the place where families come when they can no longer care for their loved ones safely at home and don’t know where to turn.
It is time that we honor all of our mothers and advocate for adequate funding for their care and a living wage for the compassionate caregivers who will be caring for those mothers on Sunday.