It is time to support long-term care services and the staff

By Betsy Johnson

The COVID-19 pandemic has taken an emotional, psychological, and yes, a financial toll on long-term care in Kentucky. Today, as the world is getting back to a “post-pandemic normal” thanks to safe and effective COVID-19 vaccines, long-term care leaders are asking themselves two main questions: How do we navigate a post-pandemic financial recovery? What can we do to recruit and retain the right people to work in long-term care?

Although these are hard questions, without easy answers; one thing is clear, COVID-19 highlighted the importance of long-term care services and our need to invest in those services and the people who provide those services.

Financial Challenges

In Kentucky, most long-term care services are defined by three levels of care: skilled nursing (highest level of care); licensed personal care (second highest level of care); and certified assisted living (lowest level of care).

Each level provides an important role in the continuum of care for our elders. Post-pandemic, these long-term care providers are facing reduced census after having spent millions of dollars on personal protective equipment (PPE), testing, and staff.

As an example, in January 2020, the average occupancy rate for Kentucky’s skilled nursing facilities was 85.3 percent. In January 2021, the average occupancy rate in Kentucky’s skilled nursing facilities was 71.8 percent. Reduced census plus increased costs equals financial crisis.

The good news is that occupancy rates are starting to stabilize. Additionally, Kentucky’s long-term care providers did receive financial assistance from the federal government during 2020 and, thanks to the Kentucky General Assembly, skilled nursing facilities received some additional financial support from Medicaid in 2021. Still, the financial uncertainty continues. The federal dollars received in 2020 have been spent and the amount of Medicaid dollars that skilled nursing facilities will receive in 2021 is simply not enough.

Although assisted living and personal services rely mostly on private pay, skilled nursing facilities are dependent on Medicaid dollars. Skilled nursing is a mandatory service under the Medicaid program, it is time that we fund those services at 100 percent.

Although it appears that we have reached the “other side” of the pandemic, we must learn from the COVID-19 experience and not forget what has happened the past 15 months. We need to ensure that our long-term care providers have the financial support necessary to protect Kentucky’s most vulnerable citizens.

Workforce Challenges

If we learned one thing in the past 15 months, we learned that long-term care workers are heroes. Whether the setting is a skilled nursing facility, personal care or assisted living community, the services provided are of the upmost importance. Long-term care workers, especially direct care staff, are the ultimate example of “essential workers.” Simply put, these workers are needed – and it is time that we invest in long-term care heroes.

Throughout the pandemic, we relied on the staff of these communities to provide companionship and care for residents. These staff members worked long hours without days off while going above and beyond to protect their residents from an invisible enemy. Long-term care employees are and will continue to be the heroes of COVID-19.

COVID-19 not only took a financial toll on long-term care, it also devasted our workforce. Workforce challenges in long-term care were already prevalent before the pandemic and now those challenges are at a crisis point. We need to invest time, energy and financial resources into the long-term care workforce so that we can ensure that our most vulnerable residents are cared for years to come.

There have been some bright spots in 2021. State Representative Kim Moser (R-64) sponsored House Bill 276, which provides temporary personal care attendants working in skilled nursing facilities during the pandemic a pathway to becoming state registered nurse aides.

Additionally, the American Healthcare Association and LeadingAge put forth a bold policy proposal to recruit, retain and develop the long-term care workforce. The proposal includes both financial assistance for long-term care workers, as well as broad regulatory reform such as common-sense immigration reform that increases opportunities for foreign-born individuals to work in the long-term care profession. 

-Betsy Johnson is president of the Kentucky Association of Healthcare Facilities and the Kentucky Center for Assisted Living.


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