Our population is getting older. What is Kentucky doing about it? | Opinion

According to the United States Census Bureau, in 2034, people aged 65 and over are expected to number 77 million, while children under the age of 18 will number 76.5 million. 2034 will be the beginning of the inevitable “graying of America.” For those providing senior services — and for those who may need those services, the question becomes, “what is Kentucky doing to invest in senior services?”

More than 10,000 people turn 65 every day in the United States. Aging is a privilege, and we have a moral obligation to ensure that our elders are well cared for in our state. Some people can age-in-place, in their own homes while living independently. However, the reality is that many people need some level of long-term care services, whether that be assisted living, memory care, or skilled nursing. This can be a stressful experience for not only the individual needing the services but also family members. Kentucky’s senior service providers are dedicated to enriching the lives of elders and provide a wide range of services, including short-term rehabilitation services so individuals can return to their homes.

Kentucky’s long-term care facilities add $5.77 billion to the state’s economy. According to the American Health Care Association’s (“AHCA”) 2021 skilled nursing facility report, over 22,000 people work in Kentucky’s skilled nursing facilities. However, the current picture for Kentucky’s long-term care sector is bleak. Due to insurmountable stress, burnout, increased competition and other factors, the long-term care workforce is struggling. According to AHCA, there was a negative 4.5% change in the assisted living sector employment since February 2020 and even worse a negative 14.4% change in nursing facility sector employment.

Meanwhile, costs continue to rise. The cost of salaries and benefits went up by 14.6%, which is a $118 million increase. The cost of using staffing agencies due to workforce shortages went up by 858%. The cost of supplies is up by 38.7%, the costs of utilities are up by 23.4%, and the cost of food has increased by 17.7%. The average nursing facility’s Medicare and Medicaid population currently stands at about 77%, which results in the skilled nursing facility’s dependence on government payors for adequate reimbursement. The Kentucky skilled nursing facility Medicaid rate has not been rebased for almost 15 years, which means that skilled nursing facilities are experiencing a Medicaid shortfall. Kentucky’s current nursing facility Medicaid rates were set based on pre-2008 operating costs and haven’t been adequately increased for the costs incurred since that time. This is not sustainable for our providers and will result in our vulnerable elders not receiving the care that they need.

Nursing facilities have had to absorb exorbitant cost increases while facilities have had to limit their occupancy due to crippling workforce shortages. In AHCA’s State of the Nursing Home Industry, April 2022, “more than half of nursing homes said they cannot sustain their current pace more than one year, and 73% of nursing homes are concerned about having to close over staffing woes.” When skilled nursing facilities must limit admissions due to workforce shortages — or even worse — close, this causes additional stress on our already overwhelmed health care system. Even the American Hospital Association (“AHA”) weighed in on the increasing pressures that are being placed on skilled nursing facilities. In a letter dated November 9, 2022, Stacey Hughes, executive vice president of AHA, wrote to United States Representatives Brett Guthrie (KY) and Madeleine Dean (PA) to express support for the Building America’s Health Care Workforce Act (H.R. 7744). In the letter, Hughes writes:

“The Building America’s Health Care Workforce Act would extend [the temporary nurse aide waiver] . . . for an additional two years following the end of the COVID-19 [public health emergency]. This extension would allow [skilled nursing facilities] to retain their workforce, while also providing nurse aides with job experience needed to become Certified Nursing Assistants. At a time when health care providers are navigating the unprecedented financial challenges caused by workforce shortages and rising inflation, your legislation would help provide much needed stability and access to care.”

H.R. 7744 has bipartisan support in Congress. Kentucky’s skilled nursing facility providers appreciate Congressman Guthrie’s leadership on this issue.

On top of all the challenges that the long-term care sector faces, additional federal regulations loom over the profession without funding to implement the regulatory mandate. The Biden Administration plans to mandate staffing minimum requirements in nursing facilities. A federal mandate of this magnitude could cause Kentucky and other states to struggle to adhere to a standard that is not uniform for all. Currently, Kentucky sits at a 4% unemployment rate. It would take dramatic funding to help find the people necessary to make this mandate work.

Again, the question is obvious. With all the current and future demands on the long-term care sector, what is Kentucky doing now to invest in essential senior services for today’s elders and the elders of the future?

Betsy Johnson is the President of the Kentucky Association of Health Care Facilities and Kentucky Center for Assisted Living.