Proposed nursing-home cuts could threaten care

To the editor,
In January, R.I. Gov. Donald L. Carcieri announced his new Medicaid Reform Plan. It seeks to divert nursing-home residents to home- and community-based care as a cost-saving measure for the state. Kathleen Lavallee, author of a recent letter to the editor (“In this case, it is not a good idea for Rhode Island to do what Vermont does,” April 21), is to be commended for pointing out that such a move would not save state dollars, only shift them to a different piece of the pie, per state law.
Obviously, care provided in the least restrictive setting possible is the ultimate goal for our elders. But as Lavallee pointed out, one need look no further than Vermont to see the results of good intentions gone awry. Given the frail and vulnerable population involved, it is crucial that systemic changes be developed with caution and expertise.
A huge and more pressing concern however, was not addressed in Lavallee’s letter. To the extent the governor’s plan is implemented, what becomes of the nursing home residents who are left behind?
When the healthier patients are diverted to home and assisted living, this leaves nursing homes to care for the sickest of the sick. One might expect a slight uptick in Medicaid payment to reflect this increase in acuity. Instead, however, the governor’s 2009 budget proposes funding cuts of more than $9 million for the care of existing nursing home residents.
To be clear, these cuts do not reflect the notion that fewer patients will live in nursing homes – they are cuts to the funding provided for those patients left behind. If passed, these cuts will have a devastating effect on the quality of care and accessibility of services needed by those who require round-the-clock skilled nursing care.
Two funding cuts in particular, one to labor reimbursement and one that helps offset inflationary increases, would have devastating effects on the care provided in our nursing homes. Under the proposed cut to labor reimbursement, nursing homes that have expended wages in accordance with state law will be left without reimbursement for those expenses. And since the formula for reimbursing nursing homes for their costs in caring for Medicaid recipients is based on historical data, the inflationary adjustment is necessary to stem further losses. Without that adjustment, nursing homes cannot keep up with the costs of fuel, food and other necessities. As a profession predominantly funded by fixed Medicaid funds, how can nursing homes make up these shortfalls? Most likely, facilities will have no choice but to cut staff and services.
Studies have shown that skilled nursing providers are under-reimbursed for the cost of care provided to the tune of millions of dollars each year. After years of dealing with funding shortfalls for Medicaid residents, nursing homes cannot absorb more cuts without taking desperate measures – measures that will impair the quality of life of their residents.
Whether the balance of the current long-term care system shifts or not, quality care requires adequate resources in all settings. And Rhode Island’s seniors deserve a long-term care system that thoughtfully evolves to meet their needs, not to balance the budget.