|
Dismantling Nursing
Homes Limit Options
By Gema G. Hernández, D.P.A
I have always said there is a right place, for the right person at a
right time, and while we really would like to avoid a placement in a
Nursing Home facility for a family member, there are situations when the
degree of frailty prevents us from keeping our loved one at home. For
those occasions when the medical and custodial care goes beyond our
physical and emotional resources a Nursing Home place could be the only
solution to our dilemma. While I am a true believer in Community Based
Care as proven by my record as Secretary (1999-2001) I also believe we
need to have a viable Nursing Home provider Network. But the plan is not
for this to happen.
For the last three
years the argument that policy makers have been hearing is that people
like to stay in their homes and in their communities, and while this is
an important issue, we need to understand that what we want and what we
need may or may not be the same. This is particularly true if the
funding for community based care is not increasing in proportion to the
need. This is particularly true if waiting lists are beginning to
escalate and Medicaid funding is being realigned in a way that they will
offer fewer services to participants or will certify as eligible only
those participants that suffer from extreme frailty. In the meantime, to
cope with the gap between need for services and appropriate funding to
address those needs, family members are being exhorted to continue their
work as caregivers while being told that the Nursing Home Industry is so
expensive that they are driving the Medicaid and aging budget, leaving
no money for other options.
It is known that
Nursing Homes have powerful lobbyists who year after year donate to
political campaigns. The Nursing Home Industry has political muscle, so
to avoid a confrontation with donors and financial supporters the
administration’s plan calls for a diversion strategy that indirectly
will force some Nursing Homes out of business without the administration
being to blame. First, if the reimbursement rate to Nursing Homes is
kept in control with no significant increases; and second, if new
regulations and demands for compliance increase, some Nursing Homes will
not be able to financially survive, particularly if their occupancy rate
continues to decrease.
Third, to control
the federal deficit and to bring balance to states’ budgets, the
eligibility criteria to qualify for Nursing Home placement has been
“unofficially” changed from having 3 impediments in the activities
of daily living to have 4 impediments, and in some cases, 5 impediments
in the activities of daily living. This translates into a less number of
individuals qualifying for Nursing Home placement. This strategy is
politically astute because it does not impose a Moratorium in the number
of Nursing Home beds nor does it argue the merits of the placement, but
simply rations access to those beds by silently modifying the frailty
level that makes a future resident eligible to be in that facility. How
can the Nursing Home Industry argued with something they are not able to
see?
To improve the
economy the administration is dependent on controlling the Medicaid
program, privatizing Social Security and moving as many elders as they
can to HMO Medicare programs. The Nursing Homes are therefore in a
collision course with the administration’s plan, but if confronted,
the administration already has a fallback position; a position that uses
the Family Caregivers mandate to divert more money to community based
care but are we really diverting more money? The sad part is that Family
Caregivers are not aware the diversion of dollars is not coming to
community based services, but to other non elder or disabled adult’s
budget categories. Without their knowledge or even consent Family
Caregivers are providing a buffer of protection from any potential
confrontation between our elected officials and the weakening of the
Nursing Home industry.
Under the plan the
Nursing Home Industry has a very limited future. First, more and more
Medicare HMO entities will accept payment capitation for both the acute
and the long term care responsibilities. The majority of the Medicare
HMOs do not own a Nursing Home nor are Nursing Homes part of the
Integrative model of care therefore; more frail individuals will not be
given the option of a placement in those facilities regardless of the
degree of frailty they experience and the ability of the family to care
for them at home.
What would happen if
Nursing Homes begin to close? What are we going to do with those frail
people? What about if the closest Nursing Home to me is 350 miles away?
Can I visit my family member regularly if that person is 350 miles from
my home?
When it comes to
addressing the needs of individuals throughout the continuum of care,
all the pieces and options should remain viable, including the Nursing
Home. And if the argument is that government needs to realign or
rebalance the community based funding, and then let us make sure the
savings generated from keeping a person in the community are reinvested
in community programs and not in unrelated budget categories to the
detriment of elders, disabled adults and family caregivers. One of the
lessons learned from the Florida Nursing Home Diversion Program in Palm
Beach and Orlando is the fact that some family members disenrolled from
the program or refused to participate in the program because they offer
very limited choices of Nursing Homes, and some of the Nursing Homes
included in the program were miles away or were ranked in the lowest
quality categories.
Government should
disclose to the Caregivers the plan and Caregivers should be aware that
even though we don’t like to place a family member in a Nursing Home,
Nursing Homes could be the right place, for the right person at the
right time.
|