DEEP CUTS? Registered nurse Roxanne Jardin works with Barbara Conheeney, a patient at Orchard View Manor Nursing and Rehabilitation Center. Nursing homes throughout the state are fearful of what implementation of the first phase of Rhode Island’s Integrated Care Initiative could mean for budgets.
Rhode Island nursing home owners have become accustomed to cuts in state Medicaid reimbursements in recent years, just as they’ve gotten used to the rapid pace of change in how they and other care providers are paid for their services.
So now that the state is embarking on a long-term project to combine the management of Medicaid and Medicare dollars that go to long-term care, they are worried that the change could just be a prelude to more cuts.
“This could cause [nursing homes] to cut staff, which would mean they can’t take the same kind of attentive care of people,” said Virginia M. Burke, president and CEO of the Rhode Island Health Care Association, which represents 65 nursing homes in the state.
“Their quality of life depends on the people who provide bedside care,” she said. “If that person has time to chat and provide individualized care, the quality of life for that person is preserved. If they have too many things to do because of understaffing, it becomes more of an assembly line.”
The change nursing homes fear is the first phase of Rhode Island’s Integrated Care Initiative, which will eventually coordinate treatment of residents eligible for Medicare, the federal insurance program for seniors, along with seniors on Medicaid, the national low-income program.
Medicare pays for seniors’ direct medical expenses, but not nursing home care. The high cost of nursing home care often exhausts personal resources to the point where they qualify for Medicaid, which does pay for nursing homes, but has been straining under the burden of an aging population. The long-term care population represents 20 percent of those on Medicaid, but 70 percent of the program’s cost, according to state officials.
By managing the payments from both programs through a single manager, the state hopes to make it less confusing for recipients and make better decisions for them through sharing information.
Changes involving Medicare will require federal approval, expected no earlier than 2015, so the state is taking the intermediate step of changing how Medicaid funds for long-term care are spent first before adding in Medicare.
For years the R.I. Executive Office of Health and Human Services has been trying to minimize the number of Medicaid recipients who receive long-term nursing care, both to reduce costs and improve their quality of life. This effort includes the Home Transition Program, made up of nurses and social workers visiting nursing home residents to see if any could move back to their community.