Current COVID-19 Surge:
The Omicron variant is highly contagious and spreading faster than earlier variants, while Delta is still in play. Even with some of the best vaccination and booster rates in the nation, we are seeing large increases in the positivity rate in communities-at-large. Currently Maryland, other Mid-Atlantic states, and New York City are in an intense ramp-up period of this surge.
Given the highly contagious nature of this variant, the dramatic increase of the positivity rate in communities, the fact that in-person visitation remains in place, and the continuing federal definition of an outbreak in a skilled nursing and rehabilitation center as a single case, it is not a surprise that at least 223 of the 225 centers in Maryland are currently in outbreak status.
The downside of this surge is that the increased demand for testing will likely slow actionable clinical results. The upside is that severe illness and deaths continue to trend much lower than in previous surges. This is likely related to Maryland’s high vaccination rate in skilled nursing and rehabilitation centers, on assisted living campuses, and in general.
At a time when hospital emergency departments are overflowing and hospital beds are in short supply, the staffing crisis and local county admission bans on some nursing homes are limiting our ability to help with the patient overflow in acute care settings. That said, the situation on the ground varies throughout Maryland and we are helping with care capacity as much as possible and where clinically appropriate.
Workforce Crisis and Staffing Concerns:
Two weeks ago, after a meeting between HFAM leaders and administration leaders, Governor Hogan announced $25 million in ARPA grants for Maryland skilled nursing and rehabilitation centers to assist with staffing, testing, vaccinations, and COVID-19 therapies. The Maryland Department of Health (MDH) plans to distribute those funds in January and April 2022.
These ARPA funds will be critically important to help to underwrite nursing home operations and staffing – particularly agency staffing. However, our sector continues to face ongoing workforce challenges that have long existed and have been exacerbated by the pandemic. Workforce recruitment and retention dramatically worsened in 2020 with the onset of the pandemic and subsequent COVID-19 surges.
Today, we are currently in a predicted workforce crisis that we have long been trying to prevent and raise the alarm about. Tens of thousands of Maryland healthcare workers have left the workforce, putting both full-time and part-time workers are in short supply. We are working steadfastly and constantly with MDH leaders on possible staffing solutions.
Amid these workforce challenges, direct care staffing agencies are charging exorbitant prices to long-term care facilities that need workers. These agencies are often charging more than double the amount operators are currently paying their staff.
It is our understanding that services, including healthcare staffing services, are not included in the current Maryland anti-price gouging statute. Together with members of the Maryland General Assembly and colleagues from other healthcare associations, we will work to change that.
In the meantime, skilled nursing and rehabilitation centers, assisted living campuses, and hospitals in Maryland and across the country are doing everything they can to recruit and retain workers, such as sign-on bonuses, wage increases, referral bonuses, gift cards, PTO, flexible scheduling, and additional training and education.
Budget Outlook:
Throughout the pandemic, skilled nursing and rehabilitation centers have continued to care for Marylanders in need who have multiple medical conditions who would otherwise receive care in a hospital at a much higher cost to the state.
Increases in the Medicaid rate over recent years have been critically important and genuinely appreciated. Unfortunately, the pandemic, our continuing fight against COVID-19, historically high workforce costs, and skyrocketing operational expenses have left Maryland nursing homes severely underfunded.
Unlike other businesses, our skilled nursing and rehabilitation centers are reliant on the state to raise prices to compensate for these extraordinary new costs.
With this in mind, we sent a proposal to Governor Hogan requesting a base increase in the Medicaid rate for nursing homes and other Medicaid providers (in addition to the 4 percent increases as part of the minimum wage increase).
This base increase in the Medicaid rate will make a huge difference to the crisis we currently face and will ensure continued access to quality care. Together, we must work on solutions to ensure that all Marylanders in need have access to care in a skilled nursing and rehabilitation center and that patients do not get backed up in hospitals, putting at risk the Total Cost of Care contract.
Looking Ahead:
We are at a critical point in our fight against COVID-19. I know all of our frontline healthcare heroes are tired, and they are frustrated for any number of reasons. Trust me, we all are. At the moment it is important to remember what is in our control, and what is not.
Dating back to the start of this pandemic, we have all been driven by a commitment to quality care and our passion for caring for Marylanders. The number one thing in our control right now is to get vaccines and boosters into the arms of residents, patients, and employees in our settings as fast as we possibly can. And all this said, our SNFs must remain a resource to our hospital partners, especially during times of COVID-19 surge.
We appreciate the opportunity to bring these important issues to your attention and look forward to our work together on solutions. In the meantime, should you have any questions or like any additional information, please do not hesitate to contact me at jdemattos@hfam.org or Hope Morris at hmorris@hfam.org.
