Nebraska is facing a crisis of ‘care deserts’ – counties that lack skilled nursing homes or assisted living centers for seniors. A group of state senators and rural residents have proposed two bills to address this issue and improve the state’s reimbursement rates for care.
The impact of care deserts on rural communities
According to State Sen. Myron Dorn of Adams, 15 of the state’s 93 counties have become care deserts in the last three years, due to the closure of 12 nursing homes and 17 assisted living homes. This has forced many seniors and their families to travel long distances for medical care, or to stay at home without adequate support.
Jeanne Gentry, who lives north of Hyannis in the Sandhills, said their home is two hours away from help for a health emergency or an injury on their ranch. She also had to stay at a care center in Broken Bow, 2½ hours away, for eight weeks after a surgery.
“You have to make a choice,” Gentry said, “does a (medical) situation deem traveling that far?”
She added that not all medical needs can be taken care of at home, and that the long drive to a hospital can lead to “tragic results” for someone who has a heart attack or a stroke.
Gentry was among the rural residents who joined 11 state senators at a press conference last week to call for an end to the expansion of care deserts in Nebraska.
The proposed bills to improve care access and quality
Dorn has introduced two bills to address the issue and attempt to halt the closure of more skilled nursing and assisted living facilities by improving the state’s reimbursement rates for care. Public hearings on Legislative Bills 941 and 942 are scheduled Tuesday before the Legislature’s Appropriations Committee.
LB 941 would increase the current Medicaid reimbursement rates for care at an assisted-living facility based on recent recommendations of a study done on behalf of the Nebraska Health and Human Services Department. The bill would also create a new rate category for facilities that provide specialized care for residents with dementia or other cognitive impairments.
LB 942 would create a new fund to provide grants to nursing homes and assisted living facilities that are at risk of closing or have closed in the past five years. The grants would help cover the costs of renovation, expansion, or reopening of the facilities, as well as staff recruitment and retention.
“We can’t continue at this pace,” Dorn said. “We have to try and find a way to stop this cycle.”
He said the bills would not only benefit the seniors who need care, but also the local economies and communities that depend on the facilities.
The support and opposition to the bills
The bills have received support from several state senators from both urban and rural districts, as well as from the Nebraska Nursing Facility Association and the Nebraska Assisted Living Association.
Jalene Carpenter, president and CEO of the associations, said the bills would help address the “gap” between the actual cost of care and the reimbursement rate from the state. She said the gap has grown to over $40 per day per resident, which has made it difficult for many facilities to stay in business.
However, the bills also face opposition from some groups, such as the Nebraska Taxpayers for Freedom and the Platte Institute, who argue that the bills would increase the state’s spending and create more bureaucracy. They also question the effectiveness and accountability of the grants program.
Jim Vokal, CEO of the Platte Institute, said the bills would not address the underlying causes of the care desert problem, such as the aging population, the workforce shortage, and the regulatory barriers. He said the state should instead focus on expanding telehealth services, allowing more home-based care options, and reducing the licensing and certification requirements for care providers.
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