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Budget abandons nursing home residents COMMENTARY Ray Calhoun

EVERY YEAR in Pennsylvania nearly 100,000 families are confronted with an anguishing, uncomfortable and often guilt-ridden decision. They must decide whether to move an ailing, elderly loved one to a nursing home.

It is a situation that plays out every day at every one of Guardian Elder Care’s 17 nursing homes located across the commonwealth. After 32 years in the nursing home profession, I know the majority of families we serve will later say that the nursing home was the right decision. Keeping their loved one at home was no longer a safe and viable option, and their loved one received high-quality, compassionate care.

If Gov. Ed Rendell’s proposed 2008-2009 budget is approved, I’m afraid that the quality of life and possibly the quality of care for many of Pennsylvania’s nursing home residents could be jeopardized. Over the past three years nursing homes have been shortchanged nearly $290 million by state government for the care of Medicaid residents. It is a fact that Rendell has not disputed.

Now he is battling to justify his proposed budget, which includes no increase in the coming year for the care of Medicaid nursing home residents, despite the rising costs of providing that care.

Two-thirds of this state’s nursing home residents are on Medicaid. In rural counties the percentage is often higher. For every one of these residents, nursing homes statewide lose an average of $12 per resident per day. Put another way, the average nursing home in Pennsylvania loses more than $4,300 a year on two out of three residents. Why? Because government is not covering its expenses, leaving nursing homes to hold the bag.

Clearly all of us prefer to remain at home for as long as we can in our later years of life. However, for those who are very sick, very frail and require round-the-clock nursing care, today’s nursing homes provide excellent care and are more like home than ever before.

Another year of inadequate funding could change that picture. After three years of under- funding, nursing homes have nowhere left to trim.

Caring for nursing home residents is physically and emotionally challenging work, yet because of chronic government under-funding most nursing homes cannot pay the wages and benefits that other health care settings can pay. Therefore, turnover is higher.

Many homes also must charge self-paying residents a higher cost for their care, thus forcing those residents to spend down their hard-earned assets sooner than they should and ultimately putting them on Medicaid sooner than they should.

In addition, this chronic under funding of our commonwealth’s most vulnerable residents comes at a dangerous time; Pennsylvania is on the verge of a boom in the elderly population. The over-65 population is going to double in the next 10 years and, according to Congressional Quarterly, nearly 70 percent of those turning 65 this year will need long-term care sometime in their lives.

Pennsylvania nursing home residents are older and sicker than the national average, according to the Centers for Medicare and Medicaid Services. We also provide more registered nursing hours per day to our residents than our neighboring states of Ohio, New York, Maryland, New Jersey and Connecticut. Yet, our Medicaid rates for nursing homes are below those of Delaware, Connecticut and New York, and virtually identical to Maryland and New Jersey.

Gov. Rendell justifies his flat funding of Medicaid nursing home residents by saying that he wants to rebalance the long-term care system and put more money into home care to keep people out of nursing homes. I commend the governor for wanting to expand home care – it is an area where Guardian is expanding services, too -- but the fact is, home care and nursing home care serve two very different populations.

Nursing homes work closely with the Area Agencies on Aging and the state Department of Public Welfare to transition residents back into their homes. But over the past five years, very few people who are in nursing homes for long-term care have been able to go home. They are too frail and sick. Home care is not a substitute for nursing home care.

I realize this is a tough budget year for the governor and state legislators. Nevertheless, the residents in our nursing homes are the men and women who fought in our wars, labored in our factories and built our communities. They deserve funding for care and programs that help them age with dignity.

The last few years have been very difficult ones in my career of caring for nursing home residents. If Medicaid reimbursements stay frozen, as the governor proposes, then the coming year will be even harder – for our elderly and disabled and for the wonderful men and women who care for them.

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