Older Nebraskans Will Have Less Access to Care if This Alarming Trend Continues

older nebraskans health care

The Cornhusker State has seen a concerning increase in nursing home closures in the last four years. All 27 of them have closed despite Nebraska’s demographics growing older, and four more have announced they will be closing this year.

Boddy, Chief Executive Officer of the Nebraska Health Care Association, spoke up about the impact this would have on citizens. He said that facilities were trying to stay afloat, figuring things out on a month-to-month basis, but it was hard going. It is difficult for them to stay solvent, and so they are forced to close to the detriment of the business and of the elderly patrons.

Two years ago, the Good Samaritan Center was a popular nursing home in Wymore that was on the road that the floats took during the Sam Wymore Days Parade. Each  year, the residents got a chance to enjoy the colorful displays of the paraders passing by.

As it had to close down, its patrons were forced to move to other nearby homes. One of them was Virginia Swift, who simply had to leave her hometown of Wymore. She had to go to another nursing home 14 miles away. While this wasn’t too far, other residents weren’t so lucky. Smaller homes in rural towns closed down, and their inhabitants had to go much further than just down the road.

Swift shared that it was not an easy move. She even testified at a hearing back in March concerning a legislative bill (LB181). The goal of the bill was to get a long-term study funded regarding the sustainability of elderly care. She told the senators that she had hoped to live out her life in the home in Wymore, but that was no longer possible.

Currently, Swift is 64 years old and is unable to walk, which is why she needs constant care. The nursing home in Wymore was a place she visited as a schoolgirl, so it was very familiar to her. She went there many times while she was young, trick-or-treating during Halloween and singing carols at Christmas time. She spent time with the residents of the home, participated in the different programs they had, and she knew she wanted to go there as well when her time came.

Four years prior, her home was destroyed because of a flood, and it was clearly time for her to make the move to the nursing home. Her neighbors were there as most of the residents were Wymore born-and-bred, all choosing to remain near their families in a home they truly felt comfortable in.

There was a continuity, Swift said, because they were still a part of Wymore despite being in a home. Volunteers still visited, as she had done so back in the day, and high school graduates would come on prom night to show off their outfits to the retirees. They were still a relevant part of the community, connecting with businesses, schools, churches, and their families and friends.

Now, all that was gone, Swift concluded.

The town was certainly impacted by this, and many more are sure to be as well. Azria Health purchased four other homes this month, which will leave 240 employees redundant. The towns of Milford, Utica, Blue Hill, and Columbus will be next to feel this loss of nursing homes in their surroundings.

Mr. Boddy explained that the payments for Medicaid recipients made by the state to those homes were below the cost of care. It is estimated that around 53% of the residents in those nursing homes rely on Medicaid. Currently, they get around $30 a day per resident, which isn’t nearly enough to cover their nursing costs at the homes. More money was appropriated for them after the Legislature session, but it still doesn’t meet the needs.

The Health and Human Services will begin a new long-term care payment method, which is to be phased-in over the next two years; this is set to start July 1.

The deputy director of that division of Medicaid, J. Brunssen, shared that the current model wasn’t transparent enough. It is difficult to understand and manage year in, year out. The goal is to have a simpler, more sustainable model in the years to come because the cost-based model currently in place is clearly not working out. Naughton, Nebraska’s HHS spokeswoman, said that the current regulations must be updated and that they needed a more modern methodology. The payments must be based on equity and must ensure quality care for all.

The main idea is that there should be a base rate for patients, which can then be tweaked depending on the acuity of the patients. Once that is set, they would adjust the quality of care accordingly. Senators have called this a “flat rate.” Whatever the term for it, the HHS is hoping it will be just the ticket to help out Nebraska’s aging population. Anyone interested in how this process is progressing can go on the HHS site and see how the payment methodology is getting updated.

The updates rates have yet to be revealed, but Boddy says they ought to be in direct relation to the average care-costs in the state. This is around $190 per patient, per day, so the disparity between what Medicaid provides at this time is more than apparent. Depending on the facility, those costs are as low as $120 to as high as $250, so there will be an evening out. Some nursing homes would get a decrease and others an increase. Because of the current payment system, Boddy shared, 29 homes had reductions this year.

Naughton added that the payments made on behalf of Medicaid beneficiaries weren’t the only thing causing the problem. Sometimes, the facilities themselves aren’t operating efficiently or lack quality staff or struggle with occupancy.

Sara Howard, an Omaha Senator and the chairwoman of the Legislature’s HHS Committee, says she’s skeptical of the flat rate idea. She says it would be a precedent as no other states use such a model. She thinks that implementing this would be quite difficult.

She is also worried that there would be even less transparency, and this lack of oversight could prove to be more harmful than helpful. The payment method that is still in place at this time provides data on the care costs, the number of Medicaid beneficiaries, the mix of the payers, and the staff ratios.

On the other hand, Senator Kate Bolz warned the other senators of the imminent nursing home closures at a Lincoln hearing on LB181. She recommends changes to the policy because quality long-term healthcare is vital to the state’s elderly. It is especially the small communities that are most in need of these facilities, so some strategy has to be set in place to help.

Experts project that there will be twice as many Nebraskans over the age of 85 by the year 2040. They will need healthcare, and Boddy said he was especially concerned about the access these people would have to it.

People will face hard decisions in the future, Boddy warns, and will find themselves driving for a very long time just to see a loved one.

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