During a House Ways and Means Committee hearing held before the congressional recess, Rep. Lloyd Doggett (D-TX) questioned healthcare witnesses about nursing home care and the workforce stability.
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NewsTranscript
00:00Mr. Doggett, I yield to you.
00:02Thank you very much.
00:03Thanks to each of our witnesses.
00:05Dr. Dongeli, I've been out to a long-term care hospital, I think similar to the one
00:12that you operate with Dr. Prettyman, who's here with you today, and seeing firsthand
00:19the big challenges you have to provide quality care to people that really need extended care.
00:26And I was alarmed by your written testimony.
00:29I didn't get to hear all of the oral, that the discharge rates to long-term hospitals
00:35are about 40% lower for those enrollees that have Medicare Advantage versus those in traditional
00:43Medicare.
00:44When someone is not approved by their Medicare Advantage plan to come to a long-term care
00:52hospital of the type you direct, what happens to them?
00:56What care do they get?
00:59One of two things can happen.
01:01They can continue to receive services in the short-term acute care hospital, which often
01:07does not provide the comprehensive services that a long-term care hospital provides with
01:12dedicated respiratory staff, interdisciplinary teams, and an integrated care plan.
01:19Or they can stay in the hospital for a period of time and then decrease to a facility that
01:25is less intense, that might not have those resources in place to meet their needs, and
01:32languish there, or perhaps transfer back to the short-term acute care hospital because
01:39of the lack of that care.
01:41Well, I think Medicare Advantage is a real problem for taxpayers since they get overpaid,
01:47as has been pointed out by the independent MedPAC, and it's a problem in terms of quality
01:53of care in this situation and others.
01:56Perhaps they've been able to maintain this position where they don't save taxpayers any
02:00money.
02:01They cost us billions of dollars in providing lesser care by the fact that they spent, invested
02:07in this Congress, $330 million in lobbying expenses between 2020 and 2024.
02:14Dr. Madison, we have visited previously about the challenges that home health care faces
02:21in Texas.
02:22I know you're aware that if a Texas legislature that is already pretty stingy with its Medicaid
02:28program has to cut it even more because more responsibility is shifted to the state, that,
02:35just like the Medicare issue, will impact what you're able to do with home health care.
02:40And I suppose overall my feeling is, Mr. Smith referenced the legislation last year, it's
02:47entirely unclear to me, especially on the long-term care hospitals, why it is we're
02:52having a hearing in March when I thought we were going to get legislation up for consideration
02:58last fall.
02:59But I suppose that's the troubling position we're in, of inattention to these issues.
03:05Certainly, Mr. Carlson, I'm pleased that you focused on the nursing home standards.
03:11You have emphasized the impact, and I want to explore that with you a little more.
03:16It's been referred to as a political decision, and I suppose that's why there was a political
03:21decision that it was worthwhile, as predicted and estimated with these standards, that we
03:26could save about 13,000 lives a year by properly staffing our skilled nursing homes.
03:32The conditions have become so bleak that the average nursing home is today turning over
03:37more than half of their staff every year.
03:40We don't have a true workforce shortage.
03:43We have a shortage, I believe, of decent working conditions, wages, and fair treatment of care
03:48workers.
03:49Nursing homes have the funds to create better working conditions.
03:53Again, referring to MedPAC, their 2023 report found that skilled nursing homes have profits
04:00that exceeded 10 percent or 22 consecutive years and were as high as 17 percent.
04:07That's with them finding that one out of five facilities have more than 100 percent of their
04:13costs fully met by Medicaid.
04:16I just ask you whether there are sufficient workers out there to meet these minimum staffing
04:21standards, despite the claims of the industry to the contrary.
04:29The first, of course, is the context of this is really important and necessary to make
04:34sure that residents get the care that they deserve.
04:37As I mentioned in the testimony, there have been numerous accommodations written in the
04:43regulation to make sure that this is practicable.
04:46The standard selected is not as high as certainly some people advocated for.
04:52It's a standard that's already met by 60 percent.
04:56The overall standard is a standard that's already met by 60 percent of the facilities
05:02in the country.
05:03There is a significant phase-in period that allows for rural facilities until 2027 and
05:142029 to fully meet these standards.
05:20And also, as I think you rightly point out, this is a retention issue to a significant
05:26extent.
05:29There's a vicious cycle in nursing facilities sometime where you're short-staffed and then
05:34terrible working conditions, and then people leave and you're short-staffed.
05:37The idea behind this regulation is to staff appropriately so it's a good environment for
05:44residents and for staff members.
05:46And then finally, I'll note that there, as I mentioned, there is a hardship exemption.
05:50If facilities try and make their very best effort, there's a demonstrated labor shortage
05:56in that region, and the facility shows that they have offered prevailing wages.
06:00They are exempted from penalties for this provision.
06:03So, in these multiple ways, the standards recognize reality and balance the need to
06:12provide good care with the other factors that have to be dealt with and understood.
06:17Thanks to each of you.