On March 11, 2020, life as we knew it changed forever: The World Health Organization declared Covid-19 a global pandemic. And in the weeks that followed, schools closed, businesses were forced to shut down, and millions of hardworking people lost their jobs.

But by March 11, 2020, long-term care facilities throughout Pennsylvania, including nursing homes, personal care homes and assisted living communities, were already preparing for a ‘new normal.’ It was only two weeks prior that the first confirmed case of Covid-19 in the United States was discovered in a nursing home in Washington state. And it was made clear then, and it remains clear today, that long-term care would become the absolute epicenter of the Covid-19 pandemic.

I can still vividly recall an early morning telephone conversation with my counterpart in Washington state. I was reaching out because, on behalf of long-term care providers in Pennsylvania, I knew I needed to learn how to prepare for this virus. What will our frontline staff need? And was this virus really as terrifying as the national news reports were telling us?

What we learned that morning, more than a year ago, remains a focal point of our messaging today: long-term care must be prioritized.

By now, you likely know about the troublesome guidance, ill-advised directives and bungled response that plagued Pennsylvania’s answer to the Covid-19 pandemic in long-term care. 

While other states throughout the country were protecting their most vulnerable senior citizens, Pennsylvania state officials were ordering a potential seizure of PPE from nursing homes. Regulators were calling for duplicative data submissions, and threatening to jail facility administrators if numbers weren’t reported accurately. And our most vulnerable residents were forced to sit by and wait for a vaccine while hospitals throughout the commonwealth vaccinated staff, patients and whoever was in earshot. 

Our most vulnerable residents were forced to sit by and wait for a vaccine while hospitals throughout the commonwealth vaccinated staff, patients and whoever was in earshot. 

To be fair: This was an unprecedented time. Everyone — our legislators, our state leaders, members of the general public — was learning. And that’s why it’s so important to look back now and learn from the past twelve months.

What could have and should have been done differently?

First, long-term care providers were at the epicenter of the pandemic, and they should have been at the forefront of any relief effort. Instead, frontline workers and the residents they serve relied on others to step up and deliver the support they needed, including: State Senator John Yudichak, who made it his mission to procure and distribute PPE to facilities in northeast PA; Senator Judy Ward, who led an effort to allow temporary nurse aides hired during the pandemic to continue their service as certified nurse aides after a disaster declaration ends; and the late Dr. Charles Shearrow, a professor at Harrisburg University who used 3-D printers to create face shields for frontline workers in long-term care. 

In the face of adversity, leaders always rise to the challenge. The long-term care sector is grateful for those legislative and community leaders who stepped up to help our staff and residents.

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Speaking of those staff members, the brave men and women on the frontlines of long-term care have truly lived up to their newfound title: healthcare heroes. Even as case counts skyrocketed during the spring and summer months, and critical supplies were nowhere to be found, our staff never lost sight of their goal to keeping their residents safe.

Just as it’s important to look back at the past twelve months, we believe it’s even more important for the future of long-term care to look forward. 

What have we learned, and what do our most vulnerable residents need? What do their caregivers need to be successful?

Here in Pennsylvania, we need a long-term investment in long-term care. The state’s Medicaid program, which pays for more than two-thirds of all care provided in the hundreds of nursing homes throughout the commonwealth, has not seen a funding increase since 2014. We must do better. Medicaid drives every investment our providers make, from being able to retain and recruit staff, to investing in care and the residents themselves. It was this underfunded Medicaid system that handicapped providers when the Covid-19 pandemic began.

We also need to think outside of the box when it comes to our workforce. The necessary frontline staff, including aides and nurses, simply does not exist. Just as the temporary nurse aide program attracted thousands of Pennsylvanians to long-term care, we need to be innovative as we attempt to fill future positions in our nursing homes, personal care homes and assisted living communities. My first letter written to Governor Wolf in March 2020 concerning long-term care was entirely focused on staffing solutions. More than one year later, we are still looking for those solutions.  

Finally, our leaders in state government must encourage an environment of collaboration. For the past twelve months, long-term care providers have been fighting to be included in conversations about our response to this health crisis. Our frontline experts are willing to share their experiences, their challenges, and – perhaps most importantly – their policy solutions. As we say during almost every legislative hearing, long-term care must be at the table when decisions surrounding the industry are being made. Collaboration and cooperation – not obstacles and obstruction – will lead to better outcomes.

Our state leaders should visit our healthcare heroes and the vulnerable seniors they serve. Only then can we ensure long-term care will have the support it needs moving forward.

So how can I best summarize this past year for those in long-term care in Pennsylvania? I’d encourage you to ask them. 

As facilities begin to reopen their doors to visitors, and as residents are reunited with their family members and loved ones, the opportunity to learn is upon us. And just as I reached out to the long-term care community in Washington state in March 2020, so too should our state leaders visit our healthcare heroes and the vulnerable seniors they serve. Only then can we ensure long-term care will have the support it needs moving forward.

Zach Shamberg is the president and CEO of the Pennsylvania Health Care Association (PHCA), a statewide advocacy organization for Pennsylvania’s most vulnerable residents in long-term care and their providers of care.

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