Though they account for just 4% of Indiana’s coronavirus cases, nursing homes have seen more than half of the state’s deaths.

By the end of December, the number of COVID-19 deaths in nursing homes was approaching 19,000. As of Dec. 13, all but 47 of the state’s 534 long-term care facilities had reported at least one death.

To explain why the virus has been so deadly in nursing homes, experts point to staff shortages, depleted resources, ineffective government regulation and outdated facilities.

Gov. Eric Holcomb has listed reform of the state’s long-term-care system among his top priorities for the 2021 legislative session.

“We’ll be working on long-term health care reform, moving to a system that focuses on outcomes and quality for Medicaid-eligible elderly citizens,” Holcomb told CNHI Statehouse Reporter Whitney Downard.

Those Medicaid-eligible citizens make up nearly 60% of the overall patient population of nursing homes, and industry advocates point out that Medicaid reimbursements fall short of covering the actual costs by nearly $30 a patient every single day.

Holcomb has suggested that funding could be tied to quality of care, a move that might help to address the fact that 92 of Indiana’s 534 nursing homes have the lowest possible rating from the federal Centers for Medicare & Medicaid Services.

Such a move couldn’t hurt, but the state must also beef up its oversight of these facilities. Patient advocates point out that, even before the pandemic, the state had fallen far behind in its routine inspections.

Lawmakers should strengthen the state’s long-term care ombudsmen program, which investigates complaints and advocates for consumers. A December 2019 audit found the program severely understaffed.

Holcomb also suggested “removing barriers to care” so that Hoosiers could “choose where they age.”

To make that a reality, though, Indiana will have to address how it funds long-term care. According to the Kaiser Family Foundation, the state in 2019 spent 58% of its relevant Medicaid allotment on nursing homes, the sixth highest percentage nationwide. The national average was 32%. Meanwhile, Indiana spent just 35% of that funding on home-care services, well below the national average of 59%.

Beginning a transition away from such strong reliance on nursing homes seems wise. Most families would prefer to keep their loved ones at home as long as they can.

Helping Hoosiers get the care they need at home would be less expensive, enabling the state to make better use of precious resources.

Still, industry advocates are right when they say the legislature’s first priority should be stabilizing the state’s long-term care system. In addition to strengthening oversight, lawmakers must make sure the state’s nursing homes have the tools to provide residents with the care they want and deserve.

And that starts with funding.

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