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Why Help at Your Nursing Home Will Be More Scarce, and Other Elderly Care Retreats

| July 5, 2011

Take a number. (Susan NYC)

Nursing homes residents may have less face-time with their caregivers after a law that revises minimum staffing levels takes effect this week.

And nursing-home residents hoping to make it back to their own home, where their care can be paid for–at lower costs to taxpayers–through a federal grant, are out of luck.

The law is part of an effort to help nursing homes deal with the $187.5 million in Medicaid cuts outlined in the state’s budget. A House-Senate budget committee rejected the first stage of a $35.7 million federal grant to help move some nursing-home residents to community-based services, including home care, with Republicans complaining that accepting the money could create a program the state would later be unable to fund.

The 8-6 vote by the Legislative Budget Commission came on a request from the Agency for Health Care Administration to use a $1.9 million installment and a $200,000 planning grant to begin laying the ground work to implement the program.

The grant might have fallen victim to the complicated politics of health care; the federal Money Follows the Person program was most recently extended in the controversial health-care reform law that Congress passed last year.

Senate Budget Chairman J.D. Alexander, R-Lake Wales, and Sen. Joe Negron, R-Stuart, voted with Democrats to approve the change. Three other Senate Republicans voted with House Republicans to block the move. Amendments in the LBC require a majority vote of the members from each chamber to pass.

Lawmakers have long looked for ways to move nursing-home residents into the community-based programs. But Republicans said some of the new initiatives would have duplicated existing state programs, and that the state would eventually have to foot the bill for the program after the grant ran out after the 2015-16 budget year.

Supporters said the move was short-sighted. Senate Minority Leader Nan Rich, D-Weston, urged other lawmakers to support the proposal. She said serving people outside of costly nursing homes would save money for the state.

“Certainly, anyone that would be pulled out would save us Medicaid money in the long run,” Rich said.

The AARP also blasted the move in a statement issued late Friday.

“This would not only have been less expensive for taxpayers, it would have helped people with mental or physical disabilities get out or stay out of nursing homes and remain where they want to be — in their homes,” said Jack McRay, the organization’s advocacy manager. “It also would have kept tax dollars paid by Florida taxpayers in Florida — rather than having them spent in other states.”

The rejection of the federal grant compounds other potential reduction in services or care at nursing homes in Florida, such as the staffing-level reduction.

Beginning this week, nursing home residents will be entitled to 3.6 hours of direct care per day, down from 3.9.

The state requires 2.5 of those hours to be from a certified nurse, down from the current requirement of 2.7 hours. In 2007, the Legislature passed a law requiring 2.9 hours of care.

Negron, who sponsored the bill, said the move could save the nursing home industry about $40 million per year, allowing them more flexibility to deal with budget cuts. Nursing homes will lose about 7 percent of their budgets.

“We were requiring these nursing homes to meet this standard, but we weren’t giving them the money to do it,” he said. “Some of these nursing homes are barely breaking even.”

Many states have no minimum staffing ratios, Negron added.

Some nursing homes may choose to offer more than the minimum hours of care, but many rely heavily on Medicaid and have already announced staff reductions as a result of the lowered requirement, said Dale Ewart, vice president of healthcare union 1199 SEIU.

Ewart said that union caregivers delivered petitions to the administrations of 41 nursing homes last week, urging them to maintain their staffing levels.

Medicaid pays for 61 percent of the total billable days in nursing homes, Medicare pays for 19 percent and the remaining 20 percent is paid for through private sources such as insurance or residents’ personal funds, according to data from the Agency for Healthcare Administration.

Cloreta Morgan, who has worked at Unity Health and Rehabilitation Center in Miami for 38 years, said the nursing home laid-off 23 staff members in light of the lowered requirements. Her job was spared because of her seniority, she said.

“We submitted a petition asking them to ignore the changes to the law, but administration never addressed it with us,” she said.

Unity Health and Rehabilitation Center did not respond to calls from a Health News Florida reporter.

Ralph Marrinson, president of Senior Care Residences in Fort Lauderdale, said most nursing homes have no choice but to cut back on staff, but that he is looking for ways to keep care consistent by decreasing paperwork and other inefficiencies that stand in the way of bedside time.

“Everyone is going back in and digging into their budget and trying to find a way to save without impacting the level of care,” he said.

Florida first implemented minimum staffing levels in nursing homes in 2001. One 2002-2007 study, funded by the Agency for Healthcare Administration and carried about by the University of South Florida, found that higher staffing levels mean fewer falls and bedsores for residents.

Face-time with caregivers also helps patients stay mentally active, said Dr. Robert Schwartz, professor and chair of the University of Miami’s Department of Family Medicine and Community Health.

“I can understand the state in terms of looking for areas to cut their budget, but as a physician it’s tough to justify that as an area that should be cut,” he said.

–Brandon Larrabee, News Service of Florida, Brittany Davis, Health News Florida, and FlaglerLive

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8 Responses for “Why Help at Your Nursing Home Will Be More Scarce, and Other Elderly Care Retreats”

  1. palmcoaster says:

    Sorry my prior posted too soon in error:
    More of these “Repulsikans” steps to benefit corporations…(in this case Nursing Homes) by taking away existing services and benefits for the health failing elderly.! Maybe this new abusive legislation to pass will terminate the State of Florida as a welcome heaven destination for retirees.
    All these extreme measures towards the less fortunate but nothing done about the tax exemptions loopholes, heavens, refunds and incentives for the mega corporations or the mega rich.

  2. becky says:

    Hmm.I believe it has to do with ‘there is no money’ . They should let the seniors stay w loves ones, and all expenses deducted from taxes. Or, Medicaid funds sent directly to families, to shop for Dr’s, etc. Only way costs are going to come down, is to get Govco out of it as much as possible. Tort reform will help as well.

  3. mike says:

    minimum staffing regulations should start with public jobs and lastly with benefits for people who worked their whole lives paying for those government slackers taking away their right to die comfortably!

  4. mara says:

    It looks like there’s some confusion here. The program the Republicans killed was meant to help “get govco out of it”. Reread the paragraph noting the AARP’s comment:

    “This would not only have been less expensive for taxpayers, it would have helped people with mental or physical disabilities get out or stay out of nursing homes and remain where they want to be — in their homes,” said Jack McRay, the organization’s advocacy manager. “It also would have kept tax dollars paid by Florida taxpayers in Florida — rather than having them spent in other states.”

    In other words, “govco” is still in it, except *now*, there are less people to do the actual work, and it will cost more. Brilliant move!

    And btw, there is “money”. It’s just that fewer people have a bigger slice of the pie, and they ain’t sharing.

  5. palmcoaster says:

    Looks like Becky has never being exposed yet to care for her elders in need.
    Care of ill elders at home when your kids are in school and the parents went to work.?..and who will look after they needs…like going to the bathroom if bed ridden, medication, etc?
    What about when your elders live to be 90’s or older? My friends Dad live to be 98 and as a retired from the NY police force he had a good pension but the last years of his illness bedridden and taken care at his kids home (to his begging) took all his monthly retirement check, his life savings and the value of his single 2 bed, 2 bath home that was rented to pay for the part-time nurse and medical, medications and supplies needed to have him humanly comfortable and free of suffering. Plus the hard work of collaboration and company of this family of three when they were not in school or at work. His son, wife and teen daughter in nursing school, didn’t take vacation for years not to leave him alone. So Becky, you don’t know what you are talking about when you never experience yet the rip off abusive gouging cost that the right to a basic need of health care is alive and well in America today. Why? simply because your “govco” is not on these Health Uncare Insurances and Pharma Manufacturers a….es at it should and as is in Europe and the whole world. Dearest Becky maybe we be lucky enough when one day you will learn the hard way, what is to be over 70 ill and bedridden and counting your pennies if you have any left after paying your private insurance pillage, to pay for someone to come and change your soiled bed diapers, so you do not rot alive!

  6. IM Agoste says:

    Thank you, palmcoaster. You’re right on target with your comments because Miss Becky has no idea what’s involved in taking care of an elderly person. Too many times the family can’t cope with a person who’s suffering from dementia, Alzheimer’s, or any of the myriad diseases that occur. Does Miss Becky know how hard it is to look after a person who has dementia. Most likely no, and if she had to take care of someone like that she’d be the first one screaming at some government agency for help. Where are her practical suggestions on getting “round-the-clock” patient care if family members are working outside the home? I am sick to death of reading the selfish comments of “get-government-out-of-our-lives” types.

  7. mara says:

    The worst part of such selfish comments is that they’re based on massive helpings of propaganda.

  8. palmcoaster says:

    You are correct Mara.
    The amount of brainwashing media and distorted ultraconservative rhetoric, while fulfilling special interest, is as pathetic as the individuals that believe it.

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