Ohio has $50M plan to shrink nursing home bed count

Older Ohioans overwhelmingly prefer to stay home and out of a nursing home as long as possible, and when in a nursing home, people primarily want the room to themselves.

This has prompted the DeWine administration to propose a $50 million fund that would buy back bed licenses from nursing homes and shrink the number of beds in the region. The fund is proposed as part of DeWine’s newly unveiled two-year operations budget proposal, which will be considered by the Ohio General Assembly.

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Even though the number of older adults in Ohio has grown, occupancy rates have fallen in nursing homes. People instead stay home with the help of health aides or seek alternatives as they get older like assisted living -- choices boosted over the years by funding programs for eligible people.

“If you would have said to me 20 years ago, we’re gonna have 100,000 more people in Ohio over age 85, but we’re going to drive nursing home occupancy rates from 92% to 81%, I would have thought, ‘Well, no, how’s that going to happen?’ But that’s exactly what happened,” said Robert Applebaum, director of the Ohio Long-Term Care Research Project, with Miami University’s Scripps Gerontology Center. “Our occupancy rates are down, even though we have way more older people.”

That has left Ohio nursing homes with a growing number of empty beds. This has been exacerbated by the pandemic, as people have died, less people have been discharged from surgery to the facilities, and others avoided the settings.

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Many nursing homes also are designed to house people with roommates. This bed buy-back program could improve quality by freeing other space and leading to more single rooms, according to Ohio Department of Medicaid Director Maureen Corcoran.

“One of the most difficult aspects of trying to control infection, and particularly COVID in the nursing homes, is the multiple occupancy rooms,” Corcoran said.

The bed buy-back program will be managed by the Ohio Department of Health with Ohio Medicaid and Ohio Department of Aging providing support.

She said the proposal is part of a broader package of quality advancement initiatives the DeWine administration is seeking to enact. The bed buying incentive program is also about prompting some providers to transition their business from just being a nursing facility to having a range of options.

“This is part of wanting to provide people with whatever their choice is so that we ... have choices for people to be supported at home, and certainly continue to have adequate high quality nursing homes for people should they need that,” Corcoran said.

There are an estimated 70,000 Ohio nursing home residents and Ohio Department of Health estimates there are about 11,000 excess beds. In some regions, there might be the right amount or too little beds but other parts of the state are over supplied.

“One of the things we would be careful about is ... we don’t want to reduce that in areas where there is already not adequate capacity,” Corcoran said.

In Ohio, beds require a “certificate of need” proving that the nursing home bed is needed. Nursing homes can sell the certificates to each other. This program would mean the state would buy the certificates back and take those beds out of circulation.

Corcoran estimates the program could buy-back up to about 5,000 beds, roughly assuming paying about $10,000 a bed, though that price isn’t set.

Pete Van Runkle, CEO of Ohio Health Care Association, which represents nursing homes, said the association previously proposed bed buy-back programs at different times in the past, but were not involved in developing this proposal from the state and don’t know any details at this time.

He said there are unanswered questions like how much the state would pay per bed.

“That will drive providers’ level of interest in selling beds and if there is interest, the number of beds that the state can buy back,” Van Runkle said.

Deputy Director Patrick Beatty said the state staff will be meeting with the nursing facility associations but haven’t received feedback yet on the proposal.

“I’m hopeful that they’ll be supportive of it. It think it will have a positive impact on their reimbursement levels, as well as the quality of care that they can focus on individuals and their nursing facilities,” Beatty said.


By the numbers: Ohio nursing homes

70,000: Estimated nursing home residents

11,000: Estimate of excess beds

$50 million: Proposed bed buy-back program

Source: Ohio Departments of Medicaid, Health