Nursing home sector on verge of collapse

State needs to step up with support for industry

MY FAMILY AND I have operated five Massachusetts skilled nursing homes for more than 65 years and we are proud of our staff and the care we continue to provide frail elders and disabled individuals who can no longer live safely in the community.

All individuals should have an opportunity to receive high quality nursing home care when they need it. However, to ensure quality resident care, meaningful state and federal government investments are immediately needed to stabilize a sector on the verge of collapse.

Over the last 10 years, the financial state of Massachusetts nursing homes has worsened so dramatically that I fear we are now in jeopardy of being unable to meet the needs of Massachusetts citizens, today and in the future.

We appreciate that the state budget has an infinite number of critical health and social demands and finite resources. However, for years, my colleagues and I have warned our elected officials of the impending peril our provider community will face if nothing is done to fix Medicaid payments to nursing homes.  Over the last 10 years, the shortfall in Medicaid payment, which covers the cost of care for close to 70 percent of all residents, has grown alarmingly, from $21 per day, per patient in 2007 to $37 today.  This is unsustainable.

This funding gap is not a theoretical problem that can wait to be addressed by future governors and Legislatures in future budgets. This problem is here. Now. We’ve already seen multiple closures and receiverships this year and more are on the way.  Closures mean jobs lost, displacement and relocation of vulnerable individuals, and longer drive distances for families to visit their loved ones.

The most recent financial data filed with state’s Center for Health Information and Analysis shows that all types of nursing facilities – family operated, not-for profit, regional, and nationally owned – are teetering on the edge.  How else would you describe a sector with more facilities operating on negative rather than positive margins?

Why is state investment so critical?  The answer is simple.  Over two-thirds of our residents rely on Medicaid to pay for their care. Because of this reliance, our ability to pay higher wages – to secure and retain direct care staff – is tied directly to government funding.  And, ominously, we have a growing vacancy problem with one in seven direct care staff positions unfilled.  That means when a resident hits the call bell for assistance, she/he may need to wait a bit longer for help.

Unlike other years, or in different times, we have run out of options to which we can reasonably turn.  Staffing cuts have reluctantly been made, pay scales have been capped, our buildings have been refinanced, and building improvements have been deferred. After all that – everything we’ve done to sustain ourselves to try to maintain quality care—we have a sector with an average of only four days of cash-on-hand.

Many of our wonderful frontline staff who work day and night to care for our residents, struggle to earn a living wage. So, they leave the job they love and have trained for, to go to other jobs that pay more even though those jobs may not be as gratifying or fulfilling. Since 2015, we have urged Gov. Charlie Baker and the Legislature to invest $90 million annually to go directly towards staff wages as part of our Quality Jobs for Quality Care Initiative.  Thus far, a $35.5 million has been funded through a direct-care add-on program.

Meet the Author

Matt Salmon

CEO/chairman, Salmon Health and Retirement/Mass Senior Care Association
Greater investment is needed immediately to prevent further erosion of the state’s nursing home system.  We are not a sector putting profit above care.  We are a profession that makes tremendous sacrifices at both the financial and personal level to give our elders what they deserve:  great care and peace of mind for them and their families.

Matt Salmon is CEO of SALMON Health and Retirement, and also chairman of the Mass Senior Care Association’s board of directors.