EDITORIAL: Indiana's nursing homes need urgent action from state leaders

Jan. 3—A series of reports over the last several months by our colleagues at the Indianapolis Star have revealed alarming problems with Indiana's nursing home system.

Not enough staff. Dangerous conditions. Lack of transparency. Widespread fraud.

The issues, many of which have festered for years, became even more glaring after the COVID-19 pandemic hit and nursing homes in the state were not prepared for the impact.

Gov. Eric Holcomb has vaguely signaled that long-term care reform is on his agenda for 2021, with some broad ideas.

That's not good enough.

What Indiana needs is a sense of urgency and clear, detailed goals for reforming a system that is not serving the best interests of residents in long-term care facilities.

Consider just this statistic: residents in long-term care facilities make up less than 1% of Indiana's population, but they account for more than 50% of COVID-19 deaths. The national average is about 39%.

What can be done? The Star's excellent reporting has provided a path to reform:

—Set stricter requirements for nursing home staffing.

Indiana's nursing homes are among the most poorly staffed in the nation.

The state and the federal government have no staffing standards tied directly to resident care, with guidelines calling only for staffing "sufficient" to meet resident needs. Other states have set clearer, and stricter, guidelines.

Prior attempts to enact standards have died at the Statehouse, where the nursing home industry has significant sway. For example, a proposal in 2019 to set a standard of 4.1 nursing and aide hours per resident per day didn't even get a hearing.

—Crack down on the practice of county hospitals directing Medicaid money away from nursing homes they own.

For years, county hospitals have been gaming the Medicaid system, the IndyStar has revealed. In Indiana, 22 county hospitals own about 500 of the state's nursing homes. A federal law that allows government-owned nursing homes to draw extra Medicaid money was meant to provide extra help for homes caring for poor and medically needy residents.

Instead, county hospitals have used hundreds of millions of dollars for their own operations. That's money that could have gone to better staffing and care for nursing home residents.

State and federal officials need a top-to-bottom study of nursing home payments and to make the necessary adjustments.

Meanwhile, Indiana lawmakers have granted county hospitals secrecy through exemptions to the state's public records law. They can get rid of the exemptions county hospitals have used to hide how much their executives are paid and how much nursing home money they divert to hospital projects.

—Fund more options for home care.

Other states devote a larger share of their long-term care Medicaid funding to home and community-based care. That allows residents to age at home but is also less expensive for taxpayers.

Indiana needs to boost funding for programs and services that allow Hoosiers to age in place, rather than being forced into nursing homes.

—Provide the funding to hire more ombudsmen for long-term care facilities to field and investigate complaints from residents.

Every state is required, under federal law, to have an ombudsman program. In Indiana, a report last year revealed that the state has less than half the field staff necessary to meet effective standards, as the program had about 14 full-time equivalent positions to serve 57,000 residents.

These suggested reforms would not be easy. They would require redirecting money in some cases, imposing new restrictions, and rethinking procedures and policies that have been in place for years. The state and nursing home operators would need to shift their way of doing business in Indiana.

But it's clear that Indiana has not made its nursing home system the priority it needs to be. And it's clear that, as conditions have deteriorated, state leaders have looked the other way.

COVID-19 has laid bare that we can't afford business as usual in Indiana. The lives of some of the most vulnerable Hoosiers are at stake.

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