The alarming facts that 93 percent of Covid-19 fatalities in Rhode Island have been among persons age 60, and over with 80 percent of them were residents of nursing homes or assisted living facilities, are loud calls for action. We believe
The alarming facts that 93 percent of Covid-19 fatalities in Rhode Island have been among persons age 60, and over with 80 percent of them were residents of nursing homes or assisted living facilities, are loud calls for action. We believe they demand that we take a careful look at our entire state system of care for older persons and reimagine how we can provide better long-term services and supports for them.
Comparative studies have shown that most of our nursing homes generally provide good quality care. We do need to try to identify why some nursing homes had such a high prevalence of Covid-19 cases and others didn’t to see what lessons can be learned moving forward. But we must also look at the larger picture. For example, the physical environments of most nursing homes have residents living in close quarters in semi-private rooms and many share a bathroom with one or more other residents. These are not optimum conditions for preventing spread of infections.
For many years we have urged our state to invest in a much wider range of homecare options that would allow many more seniors to delay or avoid completely needing residential care. In 2009 the Senior Agenda Coalition successfully pushed for a law setting a goal of spending 50 percent of state Medicaid dollars on home and community care. However, progress over the last ten years to meet that goal has been much too slow. In 2019 Rhode Island invested fewer than twenty percent of its Medicaid dollars for older adults receiving home and community-based services, with the rest paying for nursing home care. At least ten other states invest over fifty percent on home and community-based care, and the national average is forty-two percent.
Our elected leaders need to learn a lesson from this crisis, and we all need to ask ourselves tough questions about whether we’re willing to improve the situation: Will we use incentives so nursing homes can make more single rooms and baths available to Medicaid-funded residents? Will we invest the money to pay a living wage to all direct care workers in both home and residential settings? Will we expand homecare subsidies for persons who are over-income for Medicaid but lack enough savings to pay for home and community care? Will we continue to support a new homecare program called Independent Provider that allows seniors and adults living with disabilities to hire qualified individuals to provide basic non-medical homecare to them? As seniors we deserve better.
Bill Flynn is the executive director of the Senior Agenda Coalition of Rhode Island.