Volume 9 | June 2020
LeadingAge Ohio is pleased to share with you our legislative newsletter - The Aging Advocate . This monthly publication is designed to communicate what's going on in the world of aging and give you a peek at LeadingAge Ohio's 400+ members around the state. 

Please continue to support frontline healthcare workers during this time as they work to keep everyone safe.
What's Inside?
  • Visitation update
  • Supporting long-term care heroes
  • Hospice workers
  • Providers face financial uncertainty
  • Nursing homes face scrutiny during pandemic
Aging Happenings
Visitation: assisted living opens, nursing homes & adult day await guidance
As Ohio’s economy has begun to reopen, older adults have continued to shelter, both in the community and in long-term care settings. Providers have continued to protect older adults and staff while also balancing the need to fight social isolation in residents.

Earlier this month, the Administration released guidance that was co-developed with Ohio’s long-term services and supports associations, including LeadingAge Ohio, which would allow residents of Ohio’s assisted living facilities to receive visitors for outdoor visits. A hallmark of the guidelines was flexibility: that is, assisted living facilities were allowed a great deal of discretion in judging whether and when it was safe to allow visitation, and how best to schedule and structure visitation. To date, we have heard of minimal concerns or problems arising from visitation.

The Administration has signaled that it is working on similar guidance for nursing homes as well as working towards a plan to reopen adult day services (ADS); for ADS, the openings could begin soon . LeadingAge Ohio has advocated for each of these plans to be as flexible as the assisted living visitation guidance, as Ohio long-term care providers have to respond nimbly to day-to-day changes.

LeadingAge Ohio continues to work with state leaders on these reopenings and ongoing issues such as PPE, testing, and staffing shortages.

How can legislators support long-term care heroes?
Since COVID-19 was declared a pandemic on March 11, tens of thousands of Ohioans have become infected with this deadly disease. While initial efforts were heavily focused on acute settings, the deadliest surge has come in long-term care settings.

Despite this fact, frontline caregivers and other staff in nursing homes, assisted living, home care, and other congregate care settings have continued to risk their lives and livelihood everyday. Week after week facilities have struggled due to a lack of personal protective equipment (PPE), little financial support, and a constantly-evolving web of regulations and reporting requirements. The heroes working in long-term care can feel like they have their backs against the wall.

How can legislators supports the heroes in long-term care during this crisis? Here are a few ways:

  • Support legislation that protects frontline caregivers who are working in good faith during the COVID-19 pandemic (HB 606)
  • Keep the financial pressures of long-term care providers in mind as we move into the FY 2022-2023 budget process in 2021 and work with LeadingAge Ohio to ensure that legislation is supportive of those who care for our most vulnerable citizens
  • Continue to have conversations with facilities in your community to see what kinds of pressures they are experiencing during the pandemic
  • Be a strong voice for Ohio's elders and those who care for our most vulnerable citizens

Questions and concerns can be submitted to LeadingAge Ohio Director of Government Relations and Public Affairs Susan Wallace at swallace@leadingageohio.org.
Hospice workers during COVID-19
When treatment is no longer an option, hospice provides comprehensive care and supports for patients and families. This care is designed to help individuals in end-of-life situations live as well as possible, focusing on comfort, patient wishes, and quality of life.

COVID-19 restrictions have created new hurdles for hospice workers serving patients in end-of-life situations. Most hospice care occurs in the place an individual calls home, which can be a nursing facility, assisted living center, or in the community. Some facilities have asked hospices to limit visitation to patients. While some limitation is reasonable under the current pandemic, it is important that individuals’ end-of-life care needs continue to be met. 

The Centers for Medicare & Medicaid Services (CMS) has clarified that hospice workers "should be permitted to come into the (nursing home) facility as long as they meet the CDC guidelines for health care workers." While COVID continues its path, it is important to remember that hospice care workers are providing a critical service for individuals in end-of-life situations, and they must be empowered to keep working during the pandemic.
Providers face financial uncertainty during pandemic
While the health of residents and staff remains in the forefront of providers' minds, financial uncertainty and instability as a result of the pandemic are major concerns as well. Recent CMS data for Ohio nursing home providers suggest that a significant percentage have had revenue challenges due to occupancy drops, but expense challenges are also very real.

The cost of testing is one area where there is much uncertainty. While most resident testing is paid for by Medicare or Medicaid, employee testing is being billed to their health insurance.  Current baseline testing by the Ohio National Guard is being billed to an employee’s insurance, but this presents challenges: many of Ohio’s nursing homes are self-insured, so providers would bear those costs; many employees may have high deductibles, so in this case the employee would bear the cost.

Furthermore, it’s unclear if Ohio will require testing on a weekly or bi-weekly basis in the future, and if so, who will pay. A long-term care provider with several sites in Ohio reported a cost in excess of $60,000 to complete one test of all staff and some residents, with the knowledge that repeated testing will be needed to keep up with the pace of infections. While some tests cost as little as $25, the usual cost is $80 or $90 per person.

Providers are also adapting to costs stemming from the ever-rising burn rate and increasing price of PPE supplies, which must continuously be restocked, as well as the costs of supporting staffing needs. As Mike Ray, President/CEO of Green Hills Community in West Liberty, stated to the House Aging & Long-Term Care Committee earlier this month, "It's like driving with your eye on the gas tank."

LeadingAge Ohio will continue to work to engage state supports in the long-term care sector.
Nursing homes face scrutiny amid pandemic
While acute care providers have been lauded as heroic and worthy of praise, many organizations in the post-acute care sector have been villainized instead and blamed for the spread of COVID-19. The federal government has both increased scrutiny of long-term care providers while at the same time continued to provide inadequate/faulty supplies. Financial support in post-acute care has been mixed and uncertain, with fears of "take backs" widespread.

LeadingAge Ohio has continued to ring the alarm bells on the threat this pandemic poses to long-term care through repeated asks for support from the Administration and General Assembly ( see Advocacy throughout COVID-19). As this pandemic progresses, we must understand that long-term care providers -- operating in good faith serving frail elders, as well as home care and hospice providers -- should not be blamed for high numbers of cases in the population they serve. Instead, we should strive to provide supports across the entire health system.

About LeadingAge Ohio
Founded in 1937, LeadingAge Ohio is a nonprofit trade association that represents over 400 long-term care organizations and hospices, as well as those providing ancillary health care and housing services, in more than 150 Ohio towns and cities. The continuum of care reflected by the member organizations serve an estimated 400,000 elderly Ohioans daily and employ more than 35,000 persons statewide.

Want to meet with LeadingAge Ohio? Share a story? Visit a provider in your community?