The time is now to invest in long-term care, especially care at home

The staffing crisis in Minnesota nursing homes and other residential settings is reaching critical levels, taking a toll on workers and threatening the health and safety of vulnerable seniors.

Even industry leaders warn of imminent collapse. While AARP applauds Gov. Tim Walz’s recent appropriation of $50 million to nursing homes and his commitment to hiring 1,000 additional certified nursing assistants, more critical investments are needed to address the workforce crisis and protect nursing home residents. At the same time, Minnesota lawmakers must act now to make home care options more affordable and available and that includes support for the family caregivers who help keep our loved ones at home and out of taxpayer-funded facilities.

COVID-19 has been devastating to older adults and laid bare chronic problems in Minnesota’s nursing homes. At the height of the pandemic, nursing homes and assisted living facilities represented close to 80 percent of Minnesota’s COVID-19 deaths and sadly, deaths are on the rise again with the emergence of the omicron variant. Now more than ever we must reduce reliance on nursing homes and expand access to home and community-based services that offer seniors more choice and saves taxpayers’ money as in-home care costs one-third of nursing home care on average in Medicaid.

Far too many families in search of long-term care, especially care at home, enter a world that is fragmented, confusing, costly and lacking in transparency. Older adults and people with disabilities who need long-term care under Medicaid often wait up to 90 days to establish eligibility. As a result, individuals who would prefer home care end up in the last place they ever wanted to be; a nursing home. As hospitals struggle to find nursing home placements, expediting access to in-home services can help avoid unnecessary and costly admissions to nursing homes.

Several states have implemented policies that fast-track applicants likely eligible for Medicaid to start receiving services in their home when a need arises. In these states, an individual can receive services at home while their Medicaid application is being processed; and the financial risk that someone will be found ineligible is either fully assumed by the state or shared with providers. Minnesota should consider this streamlined presumptive eligibility process for our Essential Community Support and Elderly Waiver Programs.

We also must do more to support family caregivers who are the backbone of our long-term care system. Too often, individuals and their loved ones cobble together a patchwork of ways to get the services they need. A Paid Family and Medical Leave Program, along with respite care and additional in-home supports could help alleviate the financial, health and emotional stress faced by family caregivers and help retain participation in the labor force, especially by women who provide the bulk of eldercare.

To address the workforce crisis in all care settings, in-home care, nursing homes and assisted living facilities, Minnesota lawmakers must provide adequate pay and benefits, safe working conditions and career structures that enable advancement for direct care staff. These hard-working dedicated workers put their lives on the line every day and put their own families at risk as they continue to care for the most vulnerable during this crisis. AARP urges lawmakers to pass common-sense proposals that offer state facilitated private retirement programs for workers who lack a way to save at work, and a paid leave program that shares costs between employers and employees.

Without paid sick leave, front-line staff are getting ill but cannot afford to stay home, putting vulnerable seniors at risk. It is dangerous not to provide sick leave when staff are caring for medically vulnerable residents during a pandemic.

With these dynamics, nursing homes often have chronic infection control deficiencies and persistent staff shortages. That is why it is also important to ensure that new public investments in nursing homes rates be tied to quality improvements and strong oversight to ensure funds are being used to support staffing, wages and benefits.

With the upcoming session fast approaching, Minnesota lawmakers must seize the opportunity to make nursing homes safer and prioritize more options to help seniors stay in their own homes. Seniors need care they can count on. Seniors deserve better.

Cathy McLeer is the state director for AARP Minnesota, a nonprofit, nonpartisan organization with nearly 664,000 members statewide.