Advocates of expanding home and community-based services for the elderly and developmentally disabled got a boost in recent weeks.
Two recent reports — one from the Legislature’s auditor and another from the AARP — gave the advocates some ammunition in their fight.
A state Legislative Auditor’s informational report contained a lot of bad statistics related to quality of care delivered at Louisiana’s 250 or so nursing homes for about 25,000 elderly and disabled people.
The nursing homes rank among the worst in the nation on such key measures as high rates of bed sores and use of restraints among patients, according to the report. The homes also had fewest nursing staffers out of all 50 states. And the nursing homes were “far from the (national) benchmark” when it came to residents spending most of their time in beds or wheelchairs.
The auditor’s report found that a fourth of the beds at the state’s 259 Medicaid nursing homes were empty. The state paid about $840 million in the 2013 fiscal year for residents’ care. The Medicaid funds paid “per resident, per day” increased 38 percent since June 2010 because of rising costs and the number of residents in poor health.
The nursing home industry countered that things were improving and pointed to increases in facilities with a federal five-star rating, while residents were “older and sicker” than in the past.
Less than a week later, the AARP released a report that ranked Louisiana 37th in the nation, out of 50 states and the District of Columbia, in meeting the long-term care needs of its older residents.
Long-term care refers to a diverse set of services, as simple as helping with bathing or ensuring that medications are timely taken to installing hand rails that ease walking through the house, all designed to help older people and those with disabilities stay in their home rather than at an institution. Services can be provided in many locations, such as a person’s home or in a community setting such as an adult day care center.
The report put the state at 51st for its inability to provide older residents with appropriate options that limit disruptions in their lives.
The scorecard showed a high percentage of nursing home residents who don’t need a lot of care but may be institutionalized because of lack of services available in the community.
The back-to-back reports come with two significant health care policy decisions looming.
Gov. Bobby Jindal’s administration is moving toward private management of state programs that provide care for the elderly and disabled. Where nursing homes fit in the equation isn’t clear.
The general objectives are improving care through better coordination while serving more people at home with the dollars available.
Another goal goes to the heart of an issue that the state continues to wrestle with: an overreliance on institutions while demand for community-based services skyrocket.
The administration initiative comes as the state’s nursing home industry seeks constitutional protection from the budget ax .
A proposed constitutional amendment aimed at providing funding stability goes to voters in November. As part of that arrangement, nursing homes would put up extra funds via bed taxes, which would be used as state match to attract twice that in federal funds. It would enhance dollars going to nursing homes.
Another part of the constitutional change would establish a payment rate floor that could not be reduced as well as an inflation factor. It would take a supermajority vote to cut the base rate, and then the cutting authority would be limited.
The proposition causes advocates for the elderly and disabled heartburn — seeing dollars protected for institutional care while community-based services that people prefer are exposed.
The two reports provide more fodder as the debate continues. What’s the right balance between institutions and community care, and how does Louisiana get there?
Marsha Shuler covers health care policy for The Advocate Capitol news bureau. Her email address is email@example.com. Follow Marsha Shuler on Twitter, @MarshaShulerCNB. For more coverage of the State Capitol, follow Louisiana Politics at http://blogs.theadvocate.com/politics blog.