13 May 2022
In 2020, residents of long-term care (LTC) facilities accounted for 23% of Minnesota’s total COVID-19 cases and experienced 81% of total COVID-19-related deaths. More than $150 million has been spent in emergency health response at LTC facilities in Minnesota. It’s been just over two years since the pandemic. The omicron variant is still hitting long-term care facilities, with many reported cases in these facilities.
Some of the main issues associated with this problem include the lack of total workforce vaccination, poor-quality control and regulation and the vulnerability of LTC facilities residents. However, there is an urgent need to address the low staff COVID-19 vaccination rates as data suggests a strong correlation between COVID-19 incidence among LTC facilities staff and residents.
But how can Minnesota reduce the incidence and death rates of COVID-19 cases in LTC facilities in Minnesota as COVID-19 continues to linger in our communities? To connect the dots looking forward, we must look backward. Some of the problems that plague LTC facilities can tie back to their history in the United States. These include the historical social acceptance of poor infrastructure and services provided by LTC facilities, the lack of financial protection for low-income older adults who do not qualify for Medicaid, and the industrialization of LTC facilities.
Although recent efforts such as the five-point battle plan unveiled by Governor Tim Walz aim to solve this issue by providing personal protective equipment against COVID-19 and improving the staffing levels in LTC facilities in Minnesota, it has only somewhat been successful in tackling this issue. Due to the pandemic, LTC facilities still report inadequate COVID-19 protective equipment like face masks and low staffing levels. Nonetheless, the five-point battle plan serves as a window of opportunity for effective health policies to tackle the disproportionately high incidence and death rates among residents of LTC facilities in Minnesota.
In my opinion, a definitive solution to this problem is to create a task force within Minnesota to distribute funds to LTC facilities with at least 80% fully vaccinated staff. This policy proposal mirrors the Center for Medicaid and Medicare Services (CMS) vaccination requirements for healthcare providers, which requires healthcare workers participating in Medicare and Medicaid to be fully vaccinated or lose their federal funding.
The healthcare system has historically responded to financial incentives. The CMS’s total workforce vaccination mandate for the healthcare system has laid the foundation for this policy to be very successful. Following its implementation, vaccination rates in nursing homes have risen. Current data show that the COVID-19 booster shot rate is comparable to the national average for adults over 65 years of age. Therefore, creating a task force to distribute COVID-19 relief funds to only qualifying LTC facilities with at least 80% total workforce vaccination should complement the CMS’s mandate to improve the vaccination rates across all LTC facilities in Minnesota.
The CMS complete healthcare workforce vaccination policy faced numerous legal challenges and pushbacks, especially from red states, notably Texas. However, a favorable Supreme Court ruling proves this policy will withstand political challenges. Nevertheless, creating a criterion for governmental aid for health-related matters will have equity implications despite serving a greater good. Since this purposely selects only qualifying long-term care facilities to receive funding, these LTC facilities might not be the ones in the greatest need of governmental funding.
The favorable Supreme Court ruling on the CMS total workforce vaccination on Jan. 13 provides evidence within the authority of the secretary of Minnesota’s Health and Human Services to decide which long-term care facility qualifies to receive state government funding through the task force. However, there is uncertainty about its impact since it is voluntary for LTC facilities to adhere to the proposed policy, but a gamble, I believe, is worth taking.
Dr. Praise Emukah-Brown, a practicing physician, is currently completing a masters in Public Health Administration and Policy at the University of Minnesota’s School of Public Health.