Tag Archives for Medicaid

Confronting the Long-Term Care Dilemma in Uncertain Times

Published in the Pawtucket Times on January 14, 2002

 Aging advocates are about to find out how many slides you can cut the Rhode Island budgetary pie, especially when lawmakers are predicting that the state’s deficit could soar to hundreds of millions.

With the backdrop of a recession, pushing to keep funding at current levels for existing programs and services this legislative session may be their only hope as advocates for affordable health care and housing, education, disabled persons, seniors, and low-income families call for their fair share, too.

Meanwhile, CHOICES, a broad-based coalition of provider organizations and advocate organizations, will push this legislative session for more funding to keep Rhode Island seniors in their homes.

The coalition representing home care agencies, assisted-living facilities, adult day care, housing, senior center, disabled and senior advocates and Meals on Wheels, will continue its efforts to urge the General Assembly for reforms to Rhode Island’s long-term care system, said Paula Parker, Executive Director of Rhode Island Partnership of Home Care and a CHOICES member.

“Consumers must have options to choose programs and services that can provide them with greater independence in familiar surroundings,” Park told ALL About Seniors, adding that this is an underlying principle of CHOICE’S philosophy.

During the state’s prosperous years, Rhode Island’s allocation for home and community-based services slowly inched up from seven to eight percent of the state’s total long-term care budget.  Parker noted, however, that General Assembly funding for long-term care services continued to be heavily weighted toward funding institutional facility care.

“The challenge today is to continue the momentum of increasing state support for home and community-based services in less prosperous times,” Parker said, because the start’s rising elderly population creates a need to expand options in long-term care.

Susan Sweet, a consultant, long-time consumer advocate and CHOICES member, added that the seven-year-old coalition plans to continue its education efforts to inform legislators and the public about the cost savings of home and community care for elders as opposed to institutional care.

For example, Sweet stated that full-time adult day care five days a week may cost up to $ 10,000 annually as compared to an average $38,000 bill for nursing facility care.

Options in the state’s continuum of care include assistance with the costs of pharmaceutical drugs, community-based programs, rehabilitation facilities and nursing facility care. Sweet said, “A menu of available choices allows seniors and their families to seek out and receive the most appropriate and cost-effective care for their current situation. That’s what CHOICES is all about.”

Can long-term care options assist lawmakers in controlling the state budget while providing needed services for seniors?

Yes, said Sweet. “Not only is the quality of life greatly enhanced for elders and their families when institutionalization is delayed or eliminated, but also individual assets and state contributions to care through the Medicaid program are greatly reduced or eliminated,” she said.

Recognizing that lawmakers must work within severe budgetary constraints. Sweet said she believes it should be fiscally short-sided not to recognize the significant budgetary savings that home and community-based care- and preventative care- bring to situations that, without intervention, would lead to costly health care such as hospitalization and protracted institutional stays.

“The challenge for Rhode Island is to continue progress on creating less restrictive and less expensive community services while continuing funding for needed acute and long-term care,” Sweet said, stressing that in a tie of decreasing revenues, this will not be an easy task.

Lawmakers must either conform the long-term care crisis now for today’s seniors in the shadow of the state’s current budget deficit or in later years, when the state’s demographic time bomb I ready to explode. For today’s seniors and for the aging baby boomers who follow in their footsteps, lawmakers, state agencies, providers and seniors  must cooperate in crafting a seamless long-term care system with options that enhance quality of life and provide independence. This may take years.

But until then, amid competing interests for limited state dollars, advocates for better long-term care will have to roll up their shelves with the support of senior and disabled constituents to get this year’s slice of the state budget pie.

Aging Baby Boomers Woefully Unknowledgeable About Services

Published in Pawtucket Times on December 31, 2001

Are you a savvy shopper for services that you might one day need to purchase?

Many Americans are especially savvy when they purchase cars, electronic equipment or clothing.  But most are not when it comes to their knowledge of purchasing needed long-term care services, says a report recently released by AARP.

More than half (60 percent) of aging baby boomers age 45 plus say they are at least “somewhat familiar” with long-term care services currently available. However, they are woefully uninformed about the costs of, and funding sources for, long-term care services.

Yet with the graying of America’s population, the need for these services is expected to increase in the upcoming years. According to the 2000 U.S. Census Bureau projections, today’s 65 or older population numbers are expected to double to about 70 million in 2030, and the 85 and older population will also nearly double to about 8.5 million.  Those 85 years and older will be in the greatest need for nursing facility care.

“With the onset of the aging demographic revolution, essential that the general public not only learn about the long-term care options but understand their costs, and begin planning for their future care requirements,” said AARP CEO Bill Novelli. “Unfortunately, most of us pay little attention to the cost of such care until we or our loved ones needed it.  AARP sees  our role as informing and assisting people to make good choices.”

The AARP telephone survey asked a random sample of 1,800 Americans ages 45 and older questions  designed to measure their knowledge and understanding of the continuum of long-term care services, ranging from in-home care, assisted living to nursing home care.  In addition, to the national survey, five state-specific surveys were conducted with a random sample of 400 people age 45 and over in California, Florida, New Mexico, Washington and Wisconsin.

The survey findings suggested that aging baby boomers and seniors are generally not familiar or knowledgeable about the costs of long-term care services.  Only 15 percent could identify the cost of nursing  home care within plus or minus 20 percent of the national average of cost (about $ 4,654 per month).  Even 24 percent of those participating in the survey admitted that they did not even know the cost. And that’s not all – 51 percent estimated the cost too l ow.  So much for those savvy shoppers.

As for assisted-living facilities, one in four (27 percent) were able to come within a plus or minus 20 percent of the estimated median cost of care in an assisted-living facility while 38 percent said they did not know the national estimated median cost for assisted living per month, ranging from $ 2,000 and 2,500.

Meanwhile, survey participants continued to reveal their lack of knowledge by being generally unaware of how much an in-home visit from a skilled  nurse or aide costs.  The average Medicare reimbursement is $ 109 per a skilled nurse visit and $ 64 for a home visit by an aide.  The survey findings reported that they gave a wide range of answers, with no real consensus.  Thirty three percent even admitted they did not know the cost.

So, what about the aging baby boomers knowledge of long-term care insurance, one viable option to pay for the cost of long-term care services? About 31 percent said they have insurance that covers the cost of long-term care, when they probably didn’t.  Maybe it’s time for people to read the very small print in their insurance policies.  The Washington, D.C.-based Health Insurance Association of America estimates that only about 6 percent of Americas purchased such insurance.

Additionally, the survey respondents who said that they had insurance coverage for long-term care services were more likely to say they feel better prepared to meet the financial challenges of paying for care than those who say they do not have coverage (7 percent versus 39 percent).  This finding suggests that people who say that they long term care coverage when they do not may have a false sense of financial preparedness.

According to the new study, there is also a discrepancy between what people think Medicare and Medigap cover and what they actually cover.  More than half (55 percent), including those who say they are “very familiar” with long term care (58 percent), believe Medicare covers long-term nursing home stays.  And nearly a quarter say they would rely on Medicare to pay for such stays.  This is not the case.  Medicare does not cover long-term care nursing home stays.

The survey noted that 41 percent thought Medicare also covered assisted living care and more than 34 percent know whether it does or does not.  Medicare does not pay for assisted living.  And 57 percent correctly said that Medicare covers the cost of in-home visits from a skilled nurse. However, many respondents did not understand the difference between a home visit from a skilled nurse and a home visit by a home health aide.

More than half (52 percent) thought Medicare covers aide visits. In fact, Medicare covers only home health aide services for care that is medically necessary, not custodial care.

Kathleen S. Connell, AARP State Director, notes that this research study highlights the big gap between consumers understanding of long-term care services and its associated costs.  She adds that the findings reveal a great deal of confusion as to what long term care services are covered by Medicare and Medicaid.

“Aging baby boomers are now facing decisions regarding the purchase of long-term care services for their older parents. They will also be forced to deal with their need for services as they age and as longevity increases,” Connell says. “Consumers need to be come better informed about what Medicare and Medicaid pays for available long term care options for services that are actual costs of care.  They need to investigate different long term care insurance options, too,” she urges.

In Rhode Island there is a general recognition in agencies assisting seniors of the need for educating consumers and putting information into the hands of people who need it, Connell notes, adding that information specialists are available in local senior centers to assist in this effort.

Don’t wait until a sudden health crisis forces you to shop around for long-term care services.  Start today Become a savvy shopper by increasing your knowledge and understanding of different long-term care service options and  their associated costs.  Learn more about government financing programs, specifically Medicare and Medicaid, and private senior financing with long-term care insurance and Medigap policies.

Congressional report spotlights nursing home abuse

Published in The Times dated August 6, 2001

Congressional investigators have recently released a scathing report charging that within the last two years more than 30 percent of the nation’s nursing homes – about 5,285 facilities – were cited by state inspectors for at least one abuse violation that had the potential to cause harm.

These facilities were cited for almost 9,000 violations during the two-year congressional study, the report said.

Citing information gleaned from a sampling of state inspection reports or formal complaints, the 15-page report released last week at a hearing called by Henry Waxman (D-Calif), Minority Chairman of the House Committee of Government Reform, found that in more than 1,600 nursing facilities, approximately one out of every 10, the abuse violations were serious enough to cause significant harm to residents or to place them in immediate jeopardy of death or serious injury.

Abused residents were punched, choked or kicked by staff members or other residents, the report said, stating that the attacks frequently caused serious injuries such as fractured bones and lacerations.  In other instances, residents were being groped or sexually molested.

Although the report, “Abuse of Residents is a Major Problem in U.S. Nursing Homes,” prepared by Minority Staff of the Committee’s Special Investigation Division, found that the percentage of nursing facilities with abuse violations is increasing, it noted that the reasons for this increase are unclear.

In his opening remarks, Waxman stated that it had been unwise for Congress to repeal the Boren Amendment in 1997, a federal law which mandated that states provide nursing facilities with adequate funding to operate.  Because of this, he said, Medicaid funding for nursing facility care has not kept pace with the rising costs of providing care.

Waxman’s legislative prescription for attacking the growing abuse in the nation’s nursing facilities is to introduce a legislative proposal that would reestablish the abolished Boren Amendment, mandating minimum nurse staffing requirements, imposing tougher regulatory sanctions on poorly performing facilities, and instituting criminal background checks for nursing facility employees, or increasing internet disclosures on nursing facility care.

What’s playing out in Rhode Island?

According to Wayne Farrington, Chief of Facilities Regulation at the state’s Department of Health, the reporting of Rhode Island abuse complaints has risen by 10 percent.  The statewide increase in reports of abuse, neglect and mistreatment probably mirrors the tragic national problem, he tells All About Seniors, but is smaller because the Rhode Island 1987 statute has made it a misdemeanor for health care professionals or public safety officials not to report suspected abuse, neglect, mistreatment.  The size of the national increase is partially due to abuse reporting being a new requirement in some states.  Farrington added. 

Farrington states that the biggest factor that increases the number of reported calls of abuse, neglect and mistreatment is the severe statewide staffing shortage in Rhode Island’s nursing facilities.

“Overworked staff may become short tempered and this can result in abuse.  Not enough staff in the facility may also result in resident’s needs not being met,” he added.

Administrator Hugh Hall, of Cherry Hill Manor, also feels that the state’s critical staffing crisis contributes to the possibility of increased abuse and that crisis also affects the quality of care provided in the state’s 104 nursing facilities.

“Today’s nursing facility employees are underpaid, overworked creating an environment in which even the best employee may falter,” Hall said.

The administrator urges the General Assembly to increase Medicaid payments to more adequately cover the nursing facility’s actual cost of care, allowing for greater increases in direct care provider salaries.

“While last year’s average cost of care in a Rhode Island facility was $140 per day the state’s Medicaid program only reimbursed facilities $116 for the care provided, creating a serious shortage of funds in many facilities, Hall added.

“There are not enough certified nursing assistants in the system to deliver the care,” Hall said noting that opportunities must be created and a fair wage paid to attract people into this profession.

Meanwhile, Hall believes that the overwhelming majority of nursing facilities in Rhode Island provide quality care.  These facilities do criminal background checks and provide staff training.  They educate their staff about the facility’s expectation on quality patient care, he said.

Hall says facilities that have on going problems with abuse should be prosecuted to “the fullest extent of the law.”

Although Roberta Hawkins, the state’s Long-Term Care Ombudsman and Executive Director of the Alliance for Better Long-Term Care sides with Farrington and Hall about the critical need to directly confront the adverse impact of the staffing shortage in facilities, “it’s not to excuse to provide bad care,” she says.  “If facilities can’t care for residents then they should not admit them.”

A mandated continuing education program for both professional nurses and certified nursing assistants can be an effective strategy for reducing the incidence of abuse while enabling the better trained worker to care for more medically complex residents.

Additionally, Hawkins and long-term care providers are pushing for more state and federal Medicaid dollars to be allocated to provide a living wage for direct care workers.

Although lawmakers this year gave a small increase, “it’s not what was needed but it’s a start,” she acknowledges.

A divided Congress and a conservative Bush White House may well keep Waxman’s legislative proposal that addresses the problem of rising abuse in the nation’s more than 17,000 nursing facilities from every being enabled.

So, change must begin in the Ocean State.

When the Rhode Island General Assembly comes back into session next year, it becomes critical that the serious direct care staffing shortage in Rhode Island’s nursing facilities become a top legislative priority.

As the Republican and Democratic Gubernatorial candidates gear up their political campaigns and dream of becoming the state’s top elected policy official, they might well consider taking up the just cause of improving the care provided in the state’s nursing facilities.

Lawmakers can gubernatorial candidates can ill afford to ignore this key policy issue, one that puts the state’s 10,000 frail nursing facility residents in continued jeopardy of abuse, neglect or mistreatment.

On a political note, hundred of thousands of families and friends of these residents, who are voters, are watching.