State lawmakers are considering giving Ohio’s nursing homes $300 million in federal funds to recover from the pandemic with no requirements regarding caregiver pay or quality of care.
The lump sum payment in House Bill 461 would come with no requirements that the funds go to raise notoriously low salaries of the caregiver workforce or avoid homes with histories of infection control violations. Ohio, through Medicaid, spent $6.4 billion on long term care in fiscal year 2020, according to data from the Kaiser Family Foundation.
House Rep. Sara Carruthers, R-Hamilton, said occupancy rates are lower and staffing and care costs are higher in long term care facilities, a direct biproduct of the COVID-19 pandemic.
Speaking to the House Economic Development and Workforce Committee, she indicated she’d be willing to submit an amendment forbidding nursing homes that accept the funds from “discriminating” against unvaccinated employees.
In Ohio, at least 8,407 nursing home residents died of COVID-19, according to state data. During the pandemic, the Centers for Medicare and Medicaid Services cited 897 Ohio nursing homes with infection control violations, according to documents obtained via public records requests. Several dozen yielded findings of “immediate jeopardy,” the most severe violations.
In one instance, a Lancaster nursing home’s decision to group infected residents in rooms with healthy residents preceded an outbreak that spawned 173 cases in October 2020, some of whom died from the disease, according to state inspection records. A nursing home in Dayton ignored a schizophrenic man’s COVID-19 infection for several days. By the time they acted, 50 residents and 12 staff had contracted the disease.
Carruthers said it’s not her role to tell the industry how to care for its patients. She told a reporter she hadn’t heard about the infection control reports.
“I think you have that confused with New York,” she said, when asked about the report regarding the Lancaster home.
Robert Applebaum, director of the Ohio Long-Term Care Research Project at Miami University, said financial support for nursing homes that’s tied to wage boosts and incentives makes sense. A blank check? Not so much.
“Nursing homes have indeed lost a lot of money and need help, but money without oversight to me is not a good idea,” he said. “The state is missing a big opportunity to work on improvement actions.”
Rep. Jennifer Gross, R-West Chester Twp., asked Carruthers during committee if she’d submit an amendment to the bill blocking the money from any facility that “discriminates” against unvaccinated employees. Gross has been among the most vociferous anti-vaccine and anti-vaccine mandate members of the House Republican caucus.
“I don’t think that’s a problem at all,” Carruthers said.
It’s unclear how this amendment, which has not yet been formally proposed, would comport with a directive from President Joe Biden’s CMS requiring all nursing homes to vaccinate eligible staff, effective Jan. 4.
About 58% of health care workers at Ohio nursing homes are vaccinated, as of the week ending Oct. 31, according to CMS data. That said, 93% of homes reported a shortage of nursing staff last week.
Chris Murray, CEO of The Academy of Senior Health Sciences Inc., spoke to lawmakers in support of the bill. He said the industry has operated in the epicenter of the pandemic, enduring increasing costs of care, persistent shortages of protective equipment like masks and gloves, and occupancy decreases.
When committee Democrats pressed him about the lack of requirements tied to the money, he said the funds would drive better care.
“The problem you run into are the residents in those facilities that are suffering because they don’t get the care they need,” he said.
House Speaker Bob Cupp, R-Lima, said the bill will be part of a package for about $850 million remaining from the American Rescue Plan Act, which President Joe Biden Signed into law in March. Cupp said nursing homes have “significant” financial and staffing issue, as do elder home care programs.
He said he has discussed the issue with the Senate President and the governor. He declined to opine on whether the money should be tied to quality incentives, staffing or others.
“We’re not anywhere near that kind of detail,” he said.
The American Health Care Association, an industry lobby group, released data from the Bureau of Labor Statistics showing 14% jobs decrease nationally in the industry. Pete Van Runkle, who runs the Ohio arm of the association, said that as of July, the average facility was down 19 positions.
LeadingAge Ohio, which represents nonprofit nursing homes in the state, said it has been seeking federal relief funds and their use is highly regulated. Spokesman Patrick Schwartz said the funds are designed to help pay essential workers, offset revenue loss and cover COVID-19-related costs.
“From Q1 2020 to Q1 2021, wages as well as agency costs grew enormously for nursing facilities in Ohio — and they have continued to grow at an unsustainable rate.” he said. “These pressures have contributed to unsustainable increases in operating costs.”
The nursing home industry holds heavy weight in Ohio politics.
An Ohio Capital Journal investigation published in April found Ohio’s nursing home industry poured at least $6.1 million into state politics and dark money groups between 2016 and 2020. This includes $365,000 from a dark money group linked with the Ohio Health Care Association into a separate dark money entity that has since pleaded guilty to a bribery scheme that has yielded an indictment of the former House speaker and pleas of guilt from several allies.