Sudders warns of future nursing home closures

Says those that survive the pandemic may be higher quality

MASSACHUSETTS’  TOP health official is warning that nursing home closures could accelerate due to the pandemic – but she said those that survive may be the better ones.

“I’d expect we’d see more consolidations of facilities going forward, but you will see a higher quality,” Secretary of Health and Human Services Marylou Sudders told the Legislature’s Ways and Means Committee during a budget hearing on Wednesday.

The threat of nursing home closures was already a major problem before the coronavirus hit. In early 2019, senior care advocates sounded the alarm that dozens of nursing homes were financially unstable and in danger of closing. The major problem they cited was low reimbursement rates from MassHealth for nursing homes that take low-income patients.

After only three nursing home closures a year between 2015 and 2017, 14 nursing homes closed in 2018 and 18 closed in 2019.

Tara Gregorio, president of the Massachusetts Senior Care Association, said the major reason for the closures was the lack of Medicaid funding for homes that attracted significant numbers of MassHealth patients. Some had older facilities that would be too expensive to renovate.

In September, the Baker administration announced a major shift in the way it pays for nursing home care, the culmination of work done by a nursing facility task force, which issued a report in January recommending a new rate structure.  (The package also provided more coronavirus relief money, building off an earlier initiative that made funding contingent on infection control procedures.)

The rate restructuring gave an additional $82 million to nursing homes, with more money going to homes that are high-quality, high-occupancy, care for high-needs patients, and accept large numbers of Medicaid patients. Nursing homes will be required to meet minimum staffing levels and spend 75 percent of their budget on direct care staff. In lessons learned from the pandemic, the rate restructuring plan required homes to eliminate three and four-bed rooms to create more social distance.

Sudders said at the time the plan was released that it will lead to “right-sizing” the industry while holding nursing homes to higher standards.

In her testimony this week, Sudders pointed to the rate restructuring as an example of the administration’s “long-term commitment to creating high quality sustainable nursing facilities in Massachusetts.”

At the same time, she acknowledged that some nursing homes may close. Due to the massive toll COVID-19 has taken on nursing home residents, occupancy rates at nursing homes are now around 71 percent. Pre-pandemic, occupancy rates were over 80 percent. “Seventy-one percent occupancy is not sustainable,” Sudders said.

So far, three nursing homes have closed voluntarily during the pandemic — Sweetbrook in Williamstown, Wingate at Weston, and Great Barrington​ Nursing and Rehabilitation Center. Colonial Rehabilitation and Nursing Center in Weymouth, closed just before the pandemic hit. Another one, the Farren Care Center in Montague, has announced publicly that it plans to close.

The state is trying to shut down three other homes – Town and Country in Lowell, Wareham HealthCare and Hermitage HealthCare in Worcester – which state officials say did not meet state standards during COVID-19 and have historically poor performance records. The company that runs two of the three homes is contesting the termination notice.

Gregorio said the 71 percent occupancy rate may not be a fully accurate reflection of bed capacity, since some rooms that are meant for roommates are now only allowed to have one person, under state or nursing home infection control rules. She said homes that were highly occupied pre-pandemic are continuing to take new patients.

Gregorio said there is always a danger of facilities closing, and it is possible some homes have facilities that cannot be updated to meet modern infection control standards. But she said the state’s new rate structure should go a long way toward stabilizing financially struggling homes, and she thinks it is possible that nursing home capacity will shrink not through facility closures but from having fewer people to a room. “It may be that we shrink beds without shrinking the number of nursing facilities,” Gregorio said.

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Shira Schoenberg

Reporter, CommonWealth

About Shira Schoenberg

Shira Schoenberg is a reporter at CommonWealth magazine. Shira previously worked for more than seven years at the Springfield Republican/MassLive.com where she covered state politics and elections, covering topics as diverse as the launch of the legal marijuana industry, problems with the state's foster care system and the elections of U.S. Sen. Elizabeth Warren and Gov. Charlie Baker. Shira won the Massachusetts Bar Association's 2018 award for Excellence in Legal Journalism and has had several stories win awards from the New England Newspaper and Press Association. Shira covered the 2012 New Hampshire presidential primary for the Boston Globe. Before that, she worked for the Concord (N.H.) Monitor, where she wrote about state government, City Hall and Barack Obama's 2008 New Hampshire primary campaign. Shira holds a master's degree from Columbia University's Graduate School of Journalism.

About Shira Schoenberg

Shira Schoenberg is a reporter at CommonWealth magazine. Shira previously worked for more than seven years at the Springfield Republican/MassLive.com where she covered state politics and elections, covering topics as diverse as the launch of the legal marijuana industry, problems with the state's foster care system and the elections of U.S. Sen. Elizabeth Warren and Gov. Charlie Baker. Shira won the Massachusetts Bar Association's 2018 award for Excellence in Legal Journalism and has had several stories win awards from the New England Newspaper and Press Association. Shira covered the 2012 New Hampshire presidential primary for the Boston Globe. Before that, she worked for the Concord (N.H.) Monitor, where she wrote about state government, City Hall and Barack Obama's 2008 New Hampshire primary campaign. Shira holds a master's degree from Columbia University's Graduate School of Journalism.

Tim Foley, executive vice president of 1199SEIU, the union that represents nursing home workers, said closures were already occurring pre-pandemic, and the pandemic may accelerate that trend. But he, too, said the administration’s reform package – particularly the focus on staffing levels and direct care spending – is an important step “to stabilize the nursing home industry and make sure high quality nursing home care is available for those who choose nursing home care.”

Correction: This story has been corrected to note that Colonial Rehabilitation and Nursing Home closed before the pandemic. The state Department of Public Health provided incorrect information about the timing of the closure.