Michele M. Kent is president and chief executive officer of Leading Age New Jersey, the association of non-profit organizations providing aging services in New Jersey. She is a former commissioner of the New Jersey Department of Human Services.
IN JUST a few days, New Jersey will be electing a governor and 120 members of the Legislature. In all of the give-and-take of the campaigns across the state, there has been little focus on the needs of elder New Jersey residents and the rapidly changing senior care environment across the United States.
We are lucky to live in a place where as we age and our health challenges mount, we have a menu of options for our care. These options enable more and more New Jerseyans to remain at home longer before entering a nursing home or assisted-living facility.
This option – programs providing in-home services to persons who years ago would have been otherwise forced to enter a nursing home or assisted living facility – does not mean our nursing homes and assisted-living facilities are no longer needed. Or that support for them is not as important as it used to be.
On the contrary, the need for quality acute levels of care is greater than before. Because our elders are able to stay at home longer, and receive intermediate levels of care for a substantial period of time, if they do move to a nursing home or assisted-living facility, they often come in weaker, sicker and in need of a level of care that is generally more costly.
Such facilities “keep individuals who are older and ill out of the hospital system,” said Sunni Herman, executive vice president of the 180-bed Jewish Home in Rockleigh borough in Bergen County. “That, in turn, saves the government money.”
While such facilities help the aging lead a better quality of life and live longer, “government, instead of increasing the rate to cover the costs of living, reduces the rates,” Herman said.
Quality of life
This is an accurate reflection of the situation all across New Jersey. Enabling seniors to remain home longer enhances their quality of life. They live in a familiar setting, close to family and friends. And home-based care is less costly than the next steps of care in a nursing home or assisted living facility.
Too often, however, politicians and policymakers make the leap that if home-based care is effective and less expensive, then nursing home and assisted living care doesn’t need to be so expensive. That leap is not based in the real world of operating these facilities.
Take the situation at Green Hill, a nursing home and assisted living center in West Orange.
“Between costs of the services we provide and the revenue we have coming in, we currently have a monthly shortfall of $300 for each of our residents,” said Toni Lynn Davis, president and executive director.
“People are staying home longer. Our residents’ average age is 89. Hospitals are discharging sicker persons into our care. This raises our costs, yet reimbursements are falling behind, and not keeping up. It’s an ever-increasing strain on our organization.”
Dramatic increases in funding for nursing homes are not being sought. That would not make any sense in today’s fiscally challenged environment. But we’ve created a continuum of care that encompasses differing levels of costs, requiring an understanding of the differences and recognizing that acute levels of care are more costly.
Nursing homes and assisted-living facilities are increasingly challenged by the pinch created by lowered Medicaid, Medicare and other insurance reimbursements. That’s especially true in our non-profit nursing home and assisted-living sector.
Our mission-driven organizations serve a charitable purpose. Many remain based in a faith-centered environment that provides a level of benevolent care. They don’t have significant reserves to draw down. They have qualified, dedicated staff, but at levels that cannot be reduced without affecting the quality of care they provide.
Deterioration in quality of care
The sky isn’t falling – yet. But, if reimbursements and other funding continue to be reduced or remain stagnant, we will eventually see a deterioration of the quality of care New Jersey prides itself in providing our older citizens.
It is important that our leaders, come January, create a place on the agenda for a healthy discussion over how we care for our aging population. It’s important for them to understand that because we can make savings through keeping our seniors at home for a longer period of time, it does not translate into lower costs for nursing home and assisted-living care. Costs, in many cases, will be higher because we’re able to delay moving folks to a more acute level of care until they are at a different stage of life.