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Opinion: Oklahoma must reimagine long-term care

Opinion: Oklahoma must reimagine long-term care

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Like the rest of the country, Oklahoma is at a crossroads with the future of long-term care.

The COVID-19 pandemic has been devastating and deadly for families and loved ones who reside in nursing homes. What we do next is up to us. The status quo is unacceptable. We must reform how, and equally important, where care is delivered.

Poor infection control, staffing shortages and quality-of-care issues have existed for years, historically placing Oklahoma at the bottom of national rankings. Oklahoma ranked among the worst in the nation in the misuse of antipsychotic medications, pressure ulcers, hospital admissions and lack of nursing care as recently as 2018.

AARP Oklahoma advocated for critical reforms which have slowly started turning the tide. However, COVID-19 magnified the need to accelerate reforms as we begin the hard work of reimagining long-term care.

Consider this: To date, 1,579 residents and staff died from COVID-19 in Oklahoma nursing homes. How did this happen when we knew COVID-19 was coming and the methods needed to protect residents and staff?

One answer may be inferred from the number of citations issued for not adhering to infection control processes. The Oklahoma State Department of Health issued 345 citations for infection control between March 1, 2020, and February 28, 2021.

Another contributing factor is staffing. According to AARP’s COVID-19 Nursing Home Dashboard, Oklahoma continues to outpace the nation significantly in percentage of facilities with shortages of nurses and/or aides, with one-third of all facilities reporting a shortage. This is a striking statistic when you consider that facilities in Oklahoma received at least $35 million directly from the federal government, and Oklahoma taxpayers recently allocated facilities another $68 million to tackle this significant problem. Where is that money going?

It is not surprising that AARP surveys show 90% of Americans want to live independently in their own homes and communities. So, what can we do as a state? Oklahoma currently directs 70% of its long-term care spending to institutional care, with only 30% going toward home-based care. Many states have set goals to improve consumer choice, with spending going 50/50 toward each program. Other states have implemented reforms to achieve that balance, leading to better outcomes, higher customer satisfaction, and, often, cost savings.

For those who choose to live independently in their own homes, we can also better support those supporting them. Oklahoma has an estimated 530,000 unpaid family caregivers providing uncompensated care valued at nearly $6 billion annually.

Oklahoma would be wise to expand and strengthen its network of adult day centers that provide a safe place for older Oklahomans while their family caregivers work. We could also give our uncompensated family caregivers a break, both financially and with time, through expanding respite care resources and providing uncompensated caregivers tax credits for costs they incur while providing care.

Oklahoma ranks second worst in the nation in the number of low-care needs nursing home residents who could be better served in their own homes. Since the beginning of the pandemic, the Oklahoma nursing home occupancy rate has fallen nearly 13% since January 2020.

Families are choosing to keep their loved ones out of these facilities and in their homes. We have a decision as a state: Do we continue to use taxpayer dollars to prop up long-term facilities financially? Or, do we instead focus our tax dollars where they are needed most —home-based care and support for our uncompensated caregivers.

Oklahoma is well-positioned to take advantage of the many reforms available and chart our own course as we pursue “top 10” status in elder care.

Now is the time to have a frank and serious discussion on how we transition to a new care delivery model: one that recognizes the dignity and humanity of our loved ones and provides high quality and safe care in the manner and setting of their choice.

Sean Voskuhl is state director of AARP.

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