Elderly care is personal for Rep. Annie Menz (D-Norman). She recalled how her great-grandmother, who made the best sweet potato empanadas, lived with her mom until she died instead of moving into a long-term care facility.

She wondered what it would have been like if she had. What kind of care would she have received? Would she have had a community around her?

That’s what Menz wanted to learn more about from an interim study on Tuesday covering elderly care before Oklahoma’s House Health and Long-Term Care Committee.

The committee heard presentations covering staffing shortages, care complaints and service connection issues to identify ways Oklahoma — ranked 46th in the nation for its long-term services and support — can improve the quality of life for its aging population.

The state of long-term care staffing

In 2019, Gov. Kevin Stitt signed Senate Bill 280, which increased staffing ratios in nursing homes, reimbursement rates to pay for additional staff and personal needs allowances from $50 to $75 per month to go toward personal items, like a new pair of socks.

The allowance is the amount of monthly income a Soonercare-funded nursing home resident can keep, and the remainder is applied toward their cost of care. Bill Whited, the state long-term care ombudsman, said 70% of people in long-term nursing homes are on Soonercare.

Whited said the COVID-19 pandemic hit long-term care hard — over 40% of COVID-19 deaths in Oklahoma occurred in its long-term care facilities. Visitations were also restricted, which he said caused despair and hopelessness in many residents.

HB 2566 sought to address this issue in 2021 by codifying a right of access to family, contracted health care providers and compassionate caregivers — including people like hospice caregivers. It also lets residents designate compassionate caregivers who could provide care despite visitation restrictions that might be in place.

But the emotionally taxing responsibilities that have always been a part of being a caregiver are more pronounced because of the pandemic, Whited said. They had to manage dying residents and work with frustrated families during a challenging time for people across the world.

And he said they do all that without getting paid a living wage. For example, the average nursing assistant salary is $30,210.

“So, many times, a caregiver can change trajectory, and they may go to work at Hobby Lobby or McDonald's or some other setting that they can actually make more money in and have less stress and less emotional devastation that comes along with watching people that you've developed a rapport and love for pass in front of your eyes,” Whited said.

Joy McGill, Oklahoma AARP’s associate state director of advocacy, said Oklahoma ranked 48th in the nation for highest nursing home staff turnover rates, according to the Long-Term Services and Supports State Scorecard. Oklahoma was 47th in staffing levels, measured by nursing home direct care staff hours per resident and day.

Whited said staffing challenges have resulted in several long-term care facilities closing, limited admissions, and the combination of units and halls. He also said temporary emergency waivers are “used very liberally” to fill staffing needs by hiring trainees.

AARP polled Oklahoma registered voters 40 and older in 2022 and found 92% were extremely or very concerned that nursing homes may not have adequate staff.

“There's a reason that our facilities are called nursing homes,” McGill said. “These vulnerable individuals — our elders, our individuals with disabilities — deserve nursing care and the care that they need to be able to be as well as possible for as long as possible.”

What do seniors have to say?

The Oklahoma Ombudsman Program serves residents in long-term care facilities to improve their quality of life and care. The program receives complaints from residents, families or concerned citizens.

Whited said the program isn’t an enforcement mechanism, meaning it doesn’t write fines or deficiencies. Instead, it attempts to resolve complaints through investigations.

Whited shared complaint data from the 2022 fiscal year during the study, which included 3,068 complaints. Approximately 59% of the complaints were verified, and 56% were resolved to the resident’s satisfaction.

Whited said the remaining 44% were either withdrawn or no action was needed, and less than 10% of the complaints couldn't be resolved.

Here are the top five reasons behind those complaints:

• 798 complaints: Care in long-term care facilities
• 672 complaints: Autonomy choice or rights 
• 476 complaints: Abuse, neglect and exploitation, with a verification rate of about 45%
• 216 complaints: Financial or property access 
• 192 complaints: Environment

Whited added the complaints of abuse, neglect and exploitation had verification rates of about 45%. He said not all of those were directly related to a facility or staff member being an alleged perpetrator.

He also said some facilities restrict people’s right to access their financial information or property, which is a violation of Oklahoma law.

The Ombudsman Program provides this data to the Administration on Community Living federally and Oklahoma Human Services to make policy decisions.

The U.S. is getting older

The need for long-term care services isn’t decreasing. In fact, it’s on the rise as people in the U.S. get older.

The Census Bureau found that by 2034, there will be more people over 65 than under 18, resulting in what it predicts will be a “transformative decade.”

Jeromy Buchanan, the executive director of Community Living, Aging and Protective Services, said he’s observed growing concerns about aging programs shrinking or disappearing.

“[One] of these challenges that we're seeing is shrinking infrastructure when we really need to be expanding to address these future challenges,” Buchanan said.

Buchanan said people over 65 are also getting poorer as time passes, with the number of seniors living in poverty increasing from 8.9% in 2020 to 10.3% in 2021. Affordability is a barrier to accessing necessary long-term care services.

Don Blose, CEO and executive administrator of Spanish Cove Retirement Village in Yukon, said another way to build a better foundation for Oklahoma’s growing number of seniors is to make investments to help people stay independent longer.

“That’s going to be our pathway to save money,” Blose said.

What can be done to improve elderly care?

One major point of discussion surrounded options counseling, which refers to a process where individuals receive guidance as they make choices about long-term support. Senate Bill 888, approved in 2019, directed Oklahoma Human Services to create an options counseling program subject to the availability of funding.

So far, Whited said no funding has been directed to the program.

“Funding an options counseling program would give those consumers the access to a trained options counselor that could help them identify services and programs that may be able to meet their needs,” Whited said. “Things like respite, things like PACE [Programs of All-Inclusive Care for the Elderly], things like advantage waivers.”

McGill said it can be difficult for families to know their options, and it’s important for consumers to make informed decisions with Oklahoma seniors.

“Many caregivers you talk to, once they’re thrust in a moment of needing to take care of someone in a critical situation, they don't have time to do all the research,” McGill said. “They don't know what their options are. They're scared. They don't know where to turn, and things like the options counseling can really make a difference to at least give the people the opportunity to know what their options are before they have to make decisions.”

Buchanan said Oklahoma’s Community Living, Aging and Protective Services is working on building infrastructure to implement options counseling services despite not having the funding. He said it's using grant money to build a training certification program.

He hopes to form a baseline for the service and provide it to people beyond long-term health care facilities to help them thrive in their community.

“We have people who are denied Medicaid even for home and community-based services or denied, maybe, SNAP benefits,” Buchanan said. “Whatever the case may be, we need to be looking at what other services and supports are available. … That's really what options counseling is about. Not just saying ‘Well, you're not eligible,’ but ‘Let's see what we can get you.’”

Whited said the Long-Term Care Ombudsmen believes there should be a requirement for 24-hour registered nursing care in nursing homes. The current requirement is only eight hours.

The Biden Administration proposed this idea in September through the Centers for Medicare and Medicaid Services. Opponents argue this would exacerbate the already existing health care worker shortage.

He also said the Oklahoma ombudsmen think there should be dedicated funding to hire more direct care.

“It's very important that if the Legislature invests dollars into long-term care, that those dollars go to the core needs of providing the care to the residents,” Whited said.

Buchanan said continuing to develop a Multisector Plan on Aging is also important. This Oklahoma Human Services approach engages all partners who have anything to do with aging to support the needs of older Oklahomans now and in the future.

Oklahoma Human Services hosted ten listening sessions during the summer in Lawton, McAlester, Oklahoma City, Tulsa and Woodward. It also hosted tribal listening sessions and virtual sessions to develop feedback from Oklahomans, which will be used to create the plan.

“We're trying to prioritize what's important for Oklahoma and develop that future vision for where we want to be and addressing that gap from where we are and closing it to get to where we want to be,” Buchanan said.