Maryland General Assembly Update from HFAM:
COVID-19 in Long-Term and Post-Acute Care
Healthcare Heroes
Throughout the COVID-19 pandemic, nursing home and assisted living healthcare workers have proven themselves to be not just essential workers, but frontline heroes who are truly working hard and doing all they can to save lives.

We have realized more than ever that for our best teams in long-term and post-acute care, this work is a calling. There are many amazing stories of dedication, sacrifice, and compassion by long-term care professionals who continue to go above and beyond to ensure the safety, health, and happiness of residents and patients during this unprecedented time.

Here are just a few stories of individuals who have gone above and beyond to save lives and protect the safety, health, and well-being of Marylanders in need.
When Lien Bui, purchasing director of Brooke Grove Retirement Village (BGRV) in Sandy Spring, Maryland, discovered that face masks were unavailable from suppliers, she immediately stepped into action! Enlisting the help of her family and a seamstress friend, Lien and company set to work creating homemade face masks for the BGRV staff. Lien also designed and produced unique face masks that allow residents with hearing challenges to lip read through a clear panel in the mask! 
At Solomons Nursing Center staff has worked diligently across all departments to keep residents and staff safe and healthy. From the caring nurses who work extra hours, wearing PPE during direct care, and monitoring for even the slightest change in status, to the housekeeping staff who maintain a very clean environment and also have stepped up to help the nursing staff with tasks that do not require a licensed person to perform, such as helping pass out water or making beds.
Since churches have been unable to come into skilled nursing centers, Genesis Severna Park has brought church to residents! Chris and Mr. Bobby are having Bible study in the photo above. We are grateful for all team members who have gone far beyond the call of duty in providing care for residents.
The RN Hero Team of the 1st floor at Villa Rosa has continued to tirelessly take care of residents with a SMILE and kind words! Efficient and effervescent, they interact with the residents and supervisors, and communicate with families and doctors! They show up consistently, are very dependable and pick up open shifts as needed!
Message from Joe DeMattos, HFAM President & CEO


Thank you for your service to Maryland as a member of the Maryland General Assembly. Day in and day out, you are in the business of representing your constituents and all Marylanders. In our years working together, we never took for granted, and we have always deeply appreciated the sacrifices you make in doing the people’s business.

In times of challenge and strife, we are reminded of the importance of your work, and of our partnership. Together fighting the COVID-19 pandemic and economic disaster, and as we navigate our shared quest for social justice, it is clear that this work will be the most consequential of our lives.

Throughout this crisis, I have had the opportunity to speak with many of you on the phone or exchange emails. I also briefed the House Leadership in April and the Joint COVID-19 Response Legislative Work Group in May. Additionally, I held briefings with the Republican Members of Congress and the Baltimore County Leadership team.

Today, I wanted to update each and every member of the Maryland General Assembly.

In Maryland skilled nursing and rehabilitation centers, more people are recovering and surviving than dying from this virus thanks to the dedication of all the healthcare heroes that have continued to provide high quality, life-saving care. That said, many of us have lost loved ones and friends to this killer virus. Every death is to be mourned and every life is to be celebrated.

Sadly, until there is a broadly available vaccine, we will likely face future waves of COVID-19 and continue this fight together.

In the coming days, weeks, and months we will unite as government and sector leaders to navigate the best course forward. We will convene, we will tell our stories, and we will share our strengths for a better Maryland.  For context these two articles may be helpful:

So, I ask that you please read this update. Should you have any questions, email me at or Hope Morris on my team at Or, feel free to give me a call at 410-401-3095.

Most importantly, thank you! Know that we are stronger together and we will get through this.
Joe DeMattos
President and CEO, HFAM
Background, Where We Are, and Where We are Going
On March 17, New York Times columnist Thomas L. Friedman wrote about BC and AC – Before COVID (BC) and After COVID (AC). From all we have learned about this virus since then, we know that we won’t be experiencing AC for quite some time. The phrase "new normal" is overused, but most certainly in terms of healthcare in general, our sector of care, public health, and inclusion, diversity, and equity, we ARE in a new normal. Our sector is a people-helping-people enterprise engaging patients, residents, and staff to take action and become their best selves. We have a tremendous positive opportunity to redesign and rebuild our sector.

Maryland’s stay-at-home orders worked to massively flatten the curve, which is outstanding, especially given that COVID-19 is often asymptomatic. According to one study by the Centers for Disease Control and Prevention (CDC), 57 percent of older adults who tested positive did not have any symptoms but were likely infectious to others. This had a tragic impact on many skilled nursing and rehabilitation centers across the country. Given the often-asymptomatic nature of the virus and without adequate testing and PPE support from the federal government, skilled nursing and rehabilitation centers have been fighting an uphill battle. And, until there is a broadly available vaccine, we will continue this fight together.

It is important to note that when looking at long-term and post-acute care centers that have COVID positive residents, there is not any correlation between the center's size, Five-Star Rating, for-profit status, or survey history. Based on analyses done by independent researchers from Harvard, Brown, and the University of Chicago, the determining factor of an outbreak in a nursing home is simply the location of that nursing home. Overall, there is a direct correlation between COVID "hotness" in a community and a nursing home in that community.

Centers in Maryland have done broad resident and patient testing. The State completed, with lab submissions in early June, a round of universal testing of all residents, staff, and patients in Maryland skilled and rehabilitation centers – that’s approximately 27,000 licensed beds and 33,000 employees. As those numbers continue to come in, we will likely see an increase of COVID-19 positive cases. Yet, percentages of infections will be generally down compared to mid-April.

Some Ironic Tensions of the COVID-19 Pandemic and Economic Crisis

  • The long-term care sector and our hospital partners are working closer than ever. Across both settings, lives are being saved. However, more often than not hospitals and their teams are being heralded as heroes and nursing homes are being vilified. That’s why HFAM and the Maryland Hospital Association (MHA) wrote a letter to the Baltimore Sun highlighting the heroic work that employees in both settings have done during this crisis.

  • Nursing homes are saving more lives than not. During this crisis much has been rightfully spent on wages and bonuses to frontline healthcare heroes and on inflated prices for much-needed PPE -- all the while rates and revenue did not increase.

  • Because elective surgeries stopped in hospitals, rehabilitation care supported by Medicare also stopped in nursing homes. Costs massively increased while revenue massively decreased and, for the first time in decades, occupancy in Maryland nursing homes is down by 20 percent on average.

As we have mentioned, we will be fighting COVID-19 until there is a broadly available vaccine. As the State begins to open back up, we expect guidance from the Maryland Department of Health regarding visitation in our centers. HFAM has shared our recommendations with the State, and we have been advising the sector to prepare for resumed visitation since May 11.

Ongoing testing and infectious disease surveillance will be necessary, must be clinically driven, and we have to learn from other states’ mistakes. Maryland’s approach must make common sense and it will be expensive – tens of millions of dollars a year in an environment where Medicaid is already underfunded. In addition, increased staff costs and decreased census will continue at least through this year and maybe next; increased PPE costs and shortages will also continue.

Long-Term and Post-Acute Funding

On March 18, the federal government enacted legislation to provide emergency increases in Medicaid during the COVID-19 pandemic, but state governments were not required to pass those funds directly along to healthcare providers. Also, in most cases, state governments have not provided CARES Act funding relief directly to nursing homes, group homes, and assisted living campuses. Fortunately, thanks to the advocacy and leadership of our colleagues at the American Health Care Association (AHCA), the U.S. Department of Health and Human Services (HHS) has provided direct payments to Medicare and Medicaid organizations to help underwrite the work of healthcare heroes who provide quality care to those in need and to support inflated prices for PPE. While this funding has provided much needed relief, it has not been nearly enough to cover the costs of this crisis.

In terms of the state budget, the pandemic, and the economy, we are all in extraordinary and challenging times. We are thankful that before the General Assembly adjourned, a budget was passed that included a four percent increase in the long-term care Medicaid rate for FY21, which is estimated to be $28.7 million in general funds. 

This four percent increase for FY21 is critical to ensure continued access to quality care for Marylanders in need, to preserve jobs, to bend the total cost of care curve, and now to manage, get through, and recover from the COVID-19 pandemic. Long-term and post-acute care funding has always been critical to protect quality care for Marylanders in need and to protect healthcare jobs. It is now especially important given the critical role that skilled nursing and rehabilitation centers continue to play as the pandemic evolves.

We look forward to our continued work together to fully allocate the four percent increase in the long-term care Medicaid rate necessary to protect quality care for Marylanders in need, and our continued steadfast partnership to prevent any cuts to our rates during the critical times ahead.
Key Takeaways
  • Workers at skilled nursing and rehabilitation centers across Maryland are truly healthcare heroes who have continued to provide high quality care and have saved lives throughout this crisis.

  • Every single death is sad. It is important to remember that more people are recovering and living than dying from the virus.

  • We did not cause or ask for this crisis and we have been doing everything we can to keep residents and staff safe, especially given that this virus is most dangerous to exactly the type of people we care for -- older individuals and those with pre-existing health conditions.

  • Given the often-asymptomatic nature of the virus, COVID-19 likely got in to our centers through asymptomatic carriers through no fault of the individual or center. There is a direct correlation between the prevalence of COVID-19 in a community and the prevalence of COVID-19 inside a nursing home in that community.

  • Without early prioritization of testing and PPE support for our sector from the federal government, skilled nursing and rehabilitation centers have been fighting an uphill battle. Yet, they continue to provide high quality care and find innovative solutions to protect residents, connect them with loved ones, and keep staff safe and healthy.

  • Between testing, PPE, staffing, lost revenue, and increased expenses, our centers continue to face unprecedented challenges and will be fighting this virus until there is a broadly available vaccine.

  • We need assistance in ensuring that we have adequate test kits, PPE, and staff support as we navigate a new normal going forward.

  • Despite all the continuing challenges, we have a tremendous opportunity to continue working in partnership to rebuild, reform, and create a stronger long-term and post-acute care sector within the broader healthcare system for the benefit of all Marylanders.  
Visit our website to view all HFAM COVID-19 sector updates, as well as
guidance and resources from our partners.