COVID-19 exposes underinvestment in long-term care in Nevada | Watts

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This opinion column was submitted by Theresa Watts, a nurse scientist with expertise in infectious diseases, public health nursing and long-term care. 

Months into the pandemic, we know that long-term care facilities, such as nursing homes and assisted living centers have the most risk for mass spread and deaths due to COVID-19. The media often portrays poor quality care as the cause for the negative effects occurring within long-term care. The media has it wrong. Long-term care facilities are vulnerable to COVID-19 because the reimbursement structure to these health care organizations is broken. And on July 20, the reimbursement structure was further damaged when the Nevada Legislature drastically cut Medicaid to fill a $1.2 billion budget shortfall. This budget cut will come at the direct expense of our most vulnerable populations during this pandemic.

Neither Medicare (the health insurance program for people 65 years and older) nor private insurance covers long-term care. State Medicaid programs are the insurance plan that primarily covers the cost of long-term care. This means people who need long-term care must have evidence of low- or no income and must have no financial savings. The national reimbursement structure to long-term care is built so people needing such care cannot give their life’s worth to their loved ones, but instead have the government take away everything they have in their final years of life.

More:Nevada Legislature passes cuts to health care, education amid pandemic

The effects of the Medicaid budget cut will be felt for decades within Nevada long-term care facilities. Prior to the budget cut, Nevada Medicaid insurance reimbursed long-term care facilities at a rate less than it costs to provide daily care. Now, during a pandemic where the effects are mainly concentrated within long-term care, the Nevada Legislature decided to further reduce the long-term care reimbursement cost.

With this Medicaid budget cut, long-term care facilities may not have enough funds for minimum levels of service and funds to invest in staff, care, or to update degrading infrastructure. Additionally, the Medicaid budget cut could contribute to rising health care needs and costs in acute and hospice care. The discrepancy between actual cost and Nevada Medicaid reimbursed cost of long-term care demonstrates the Nevada Legislature’s underinvestment and lack of value for long-term care.

Between mandatory restrictive visitor policies, cancellation of communal activities and faulty personal protective equipment sent to these facilities by FEMA, it seems clear that the U.S. has failed people who live in, work in, and have loved ones in long-term care. In Nevada, there have been more than 2,000 COVID-19 cases and more than 200 deaths among residents who live in, and staff who work in these settings. That’s more than 2,000 illnesses and 200 deaths influenced by the persistent national underinvestment, inefficient care reimbursement structure, general lack of political attention and age discrimination that plagues the U.S. health care system.

The COVID-19 pandemic has highlighted the need for creating meaningful improvement in long-term care. This improvement can start by fixing a broken reimbursement structure. As I look forward, I hope to see a health system built on valuing long-term care as an essential service for Nevadans. No doubt, Nevada is going through a difficult time. However, Nevada’s most vulnerable citizens to the COVID-19 pandemic deserve a system that honors their humanity and is built upon equity and respect.

Theresa Watts currently works as an assistant professor at the Orvis School of Nursing at the University of Nevada, Reno and as an infection control nurse at a skilled nursing facility.

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