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Patient Acuity Adding to Pressure on Nursing Homes

March 15, 2019

By Michael P. Norton

State House News Service

BOSTON -- Nursing homes in Massachusetts are caring for residents with more complex medical needs while patients who used to be admitted to facilities are instead being cared for in their own homes, according to a top state health care official.

Health and Human Services Secretary Marylou Sudders on Monday predicted additional nursing home closures across Massachusetts and told lawmakers during a budget hearing in Needham that state officials need to come up with ways to address the nursing home industry’s long-term future.

There are more than 400 nursing homes in Massachusetts operating 45,000 beds, according to Attorney General Maura Healey. The Massachusetts Senior Care Association says its member organizations -- which also include other residential care facilities -- serve more than 120,000 people a year, employ more than 77,000 people, and contribute more than $4 billion annually to the state economy. In an op-ed last month, the association estimated 20 nursing homes in Massachusetts closed in 2018.

At Monday’s Joint Ways and Means Committee budget hearing in Needham, Health Policy Commission Executive Director David Seltz said patients released from hospitals who previously would have been admitted to nursing homes or rehabilitation facilities are instead being treated in their homes.

“That’s a good, positive trend because it’s treating people in the most appropriate setting and using technology and visiting nurses to do this,” Seltz said.

However, the trend is also creating a “real challenge” for nursing homes, Seltz said, which are losing “less complex” residents and treating residents with “much more complex” medical needs that require additional resources in nursing homes.

Seltz said a project the commission is working on this year will address some issues with nursing homes. He said the project will look back on how health care delivery has changed in the past five years and look ahead to “where do we see it five years from now.” Impacts of industry consolidation will be part of the research.

“There’s an opportunity for all of us to think a little bit longer term and bigger picture about how the delivery of health care is changing,” he said. “I feel like sometimes we get very stuck in the right now and the right moment, and reacting to this one thing.”

Ray Campbell, executive director of the state Center for Health Information and Analysis, said his agency has a wealth of information about nursing homes, much of it collected over “decades” in connection with rate-setting processes.

The agency is working with health and human services officials and industry stakeholders, Campbell said, “to make this data more available so people can start analyzing trends around utilization and financial stability and profitability and things like that.”

“It actually represents an incredibly rich history of the evolution of the nursing home industry in Massachusetts,” Campbell said.

Industry officials say nursing homes are “facing a crisis,” as Damian Dell’Anno, co-founder and CEO of Next Step Healthcare, put it in a Feb. 26 op-ed. Nursing home residents funded through MassHealth are under-funded on average by $38 per resident, per day, according to Dell’Anno.

“Relocating people, especially fragile people, from their home is a traumatizing experience - for those displaced, for the workers who have to find other jobs, and for those charged with overseeing it,” Dell’Anno wrote in the Taunton Daily Gazette. “And as much as we don’t want to hit the replay button, more are set to close this year.”

Healey on Wednesday announced settlements with seven nursing homes that include fines and quality improvement measures after a statewide investigation discovered failings that led to injuries, and in some cases patient deaths.

In one facility, a patient died after becoming caught in “outdated and faulty” bed rails, Healey said at a press conference. Another patient died after staff failed to administer medication that could have prevented a fatal blood clot.

“My hope today is that entities operating in the state will live up to expectations of quality of care and quality of life and if they don’t they’ll have to answer to our office,” Healey said.

Officials said the industry is facing severe financial and demographic challenges that have led to “cutting corners” and shortages in staffing or substandard training that is affecting the level of care seniors receive.

The nursing homes caught up in the “major and significant statewide investigation” Healey announced Wednesday will pay $500,000 in fines that will go into a fund operated by the Department of Public Health to monitor and improve nursing home care.

Settlements were reached with Oxford Rehabilitation and Healthcare Center in Haverhill, Jewish Nursing Home of Longmeadow, Woodbriar Health Center in Wilmington, Beaumont Rehabilitation and Skilled Nursing Center in Westborough, Braemoor Health Center in Brockton, Wakefield Center in Wakefield and The Rehabilitation and Nursing Center at Everett. Healey said that Synergy Health Care, which operates the Brockton and Wilmington facilities, will also be barred from doing business in Massachusetts for seven years.

One in four nursing homes have occupancy rates of 80 percent or less, which Sudders on Monday said is “not sustainable,” and the average occupancy rate is 86 percent. As the state’s elderly population expands, state officials need to rethink nursing home rates and come up with a long-term plan while advancing a short-term $25 million package to stabilize nursing homes, Sudders said.