Even as many Galveston County residents begin to imagine a future after the coronavirus pandemic, Kimberly Mostek, administrator at Gulf Healthcare Center in Galveston, is unsure life ever will return to what it was before at long-term care facilities, she said.
Because long-term care facilities were hotbeds of coronavirus outbreaks in the early months of the pandemic, state and business leaders forced changes in how the industry operates — clamping down on how many jobs members of a mostly transient workforce could take at a time and requiring more protective equipment to interact with residents.
Although the number of COVID cases is declining, those changes and the added costs they drove are here to stay, Mostek said. That means the long-underfunded industry is in trouble without state help, she said.
“Without help, we’re going to have no choice but to cut staff,” Mostek said.
About two-thirds of Texans in long-term care facilities are covered by Medicaid, said Cara Gustafson, a spokeswoman for United in Care, a coalition formed to advocate for better Medicaid reimbursements for long-term care facilities.
Before the pandemic, Texas ranked 49th in the nation for its Medicaid reimbursement rate, Gustafson said. During the worst months of the pandemic, state leaders approved a funding increase of about $19.63 a day, from about $141 a day to $160, to help facility operators offset added costs.
That increase is set to expire at the end of July, however, and facility operators across the state are worried about what that might mean for the future of the industry, Gustafson said.
It’s not exactly clear where the Texas Legislature sits on the request. The $285 million needed to maintain the current level of funding through 2023 was not included in the state’s budget but was included in a wish list, Gustafson said.
Officials are working with legislators to secure the funding, Gustafson said.
Galveston County legislators didn’t immediately respond Tuesday to requests for comment about whether they supported keeping the higher reimbursement rate.
Dealing with COVID-19 has been an expensive proposition for facilities caring for the aged and frail, who were among the most vulnerable.
Take for example the cost of something as simple as a case of medical gloves. They were used even before the pandemic, but that took on new importance as more patient interactions required personal protective equipment, Mostek said.
Before the pandemic, Mostek could purchase a case of gloves for Gulf Healthcare Center for about $29. That cost skyrocketed to $141 at the pandemic’s height, and has decreased only to about $107 a case recently.
And personal protective equipment doesn’t come close to the biggest part of a facility’s budget — employee payroll, Mostek said.
Long-term care facilities struggled even before the pandemic with a low-paid, mostly transient workforce, Gustafson said. Because many nurses and aides weren’t properly compensated, they often took shifts at multiple facilities, she said.
And, because facilities had a hard time attracting talent, they relied on this transient workforce to paper over staff shortages, Gustafson said.
But state leaders, in response to major virus outbreaks at long-term care facilities, eventually prohibited nurses and aides from working at more than one place a time, Mostek said.
“It was a good decision at the time,” Mostek said.
But Mostek was forced to increase staffing in response to the directive, she said. Before the pandemic, an average shift at Gulf Healthcare Center was about five aides and three nurses per shift; now it’s about seven aides and four nurses.
And many employees left the long-term care industry for higher-paying jobs with other health providers because of stagnant wages, Gustafson said.
With the realization they won’t be able to work more than one job for the foreseeable future, those workers are unlikely to return, she said.
Facilities have been hit with the perfect storm, as the increase in required staffing came right as more and more families pulled their loved ones out of long-term care facilities, Mostek said.
Gulf Healthcare Center housed about 90 residents before the pandemic, Mostek said. Now its client count rarely is out of the 60s, she said.
If the Texas Legislature doesn’t keep Medicaid funding at the higher, pandemic levels, that will mean a loss of more than $24,000 per month from the facility’s budget, Mostek said.
Mostek on Tuesday wasn’t sure what the loss of funding would mean beyond cutting her staff, but it would have serious consequences, she said.
This funding model is unsustainable, Gustafson said.