In the most recent battle to change the way Louisiana cares for its elderly, nursing home owners were pitted against advocacy groups like the AARP, asking the state to increase opportunities for senior citizens to receive care in their own homes.
On Tuesday, the nursing homes won.
With a 6-2 vote, the Senate Health and Welfare committee rejected legislation aimed at giving more people access to home-health services, in lieu of being sent to a nursing home to live.
“Today, many members chose to ignore the tens of thousands of older adults in their districts who want to live at home, while offering no alternative or plan to help them,” said AARP of Louisiana lobbyist Andrew Muhl. “It was disappointing, but we always knew this would be an uphill fight.“
The Louisiana Nursing Home Association, representing 250 nursing homes in the state, spoke against the measure, saying it would result in a reduction in the quality of care.
The measure's sponsor, Sen. Conrad Appel, R-Metairie, called Senate Bill 357 one of the most important pieces of legislation lawmakers would deal with this session because it addresses the needs of Louisiana's aging population and attempts to mitigate the skyrocketing Medicaid costs required to care for their needs.
The elderly and disabled Medicaid population makes up the majority of the state’s Medicaid costs, which in large part is paid out to nursing homes.
SB357 attempted to move the Medicaid population in nursing homes under a managed care model, which means the state hires private insurance companies to make decisions about whether people should be cared for in nursing homes or at their own home with supports and staffing. Home- and community-based care is both less expensive and overwhelmingly preferred by elderly people, AARP surveys claim.
The home-based providers equip elderly or disabled people with medical support in their own home. They also provide staff who help clean, cook, dress and run errands for those in need of daily assistance. There’s 28,000 people on a waiting list for these home-based services.
"What this does is give people a critical life choice that has been denied to them in the past," Appel said. "Either stay at home or go to a nursing home."
Louisiana’s nursing homes are among the worst in the nation, according to national rankings. Louisiana also spends less on home- and community-based services than most other states. At the same time, nursing homes have unique financial protections that ensure regular rate increases, while other Medicaid providers have been cut year after year.
Several senators, including committee Chairman Sen. Fred Mills — who owns an interest in a Breaux Bridge nursing home — raised concerns that managed care was too risky and unreliable a method for the state to take on for its seniors, despite the fact that the vast majority of Louisiana's Medicaid population is already under managed care.
Mills raised concerns that managed care would result in an increase in medical claims being denied by insurance companies.
Appel dismissed the concerns about managed care as political misdirection.
“We have a huge managed care system in place in Louisiana for 1.3 million people. Those are just talking points,” Appel said. “We have ample evidence of the success of the managed care model in Louisiana.”
Proponents of the bill said it would be at a minimum revenue neutral but most likely generate savings for the state over the next few years, in large part because the state charges managed care companies a 5.5 percent tax that could generate about $100 million a year.
State Sen. Jay Luneau, D-Alexandria, was incredulous about the claim.
He said if the goal is to give home- and community-based services to thousands of people on the waiting list, then the state would have to incur additional costs to serve a new population.
He said he'd prefer to improve access to home- and community-based services with more direct funding.
Luneau also said he was concerned about diminishing care for the elderly. He noted that people in nursing homes are within walking distance of people who can assist them 24 hours a day. But with home-health providers, they would only receive help a few hours a day.
Hugh Eley, a retired 30-year administrator for Louisiana Department of Health, told Luneau that many people in nursing homes and who are on waiting lists for services can get by with a few hours of help per day. Those who can’t, would still be allowed to go to nursing homes.
The Senate hearing was packed with nursing home leaders, including several former lawmakers who have ties to the industry or were major beneficiaries of nursing home campaign donations, like former Speaker of the House Jim Tucker, former state Rep. Sherri Buffington — who often carried legislation on behalf of nursing homes — and former state Sen. Joe McPherson, who previously chaired the Senate Health and Welfare Committee.
Rep. Bob Hensgens, R-Abbeville, who is a nursing home administrator, also sat in on the hearing, watching from the back of the room.
“This is emotional to me. It’s disturbing to me,” McPherson told the committee. “I don’t want to have to deal with insurance companies. There’s definitely a need for more home- and community-based services, but this is not the vehicle.”
On Wednesday, the House Health and Welfare Committee is scheduled to take up a similar bill sponsored by Prairieville Rep. Tony Bacala. Bacala said he was unsure if he’d pursue the bill because even if he got it passed in the House, it would likely die the same death of Appel’s bill once it made it to the Senate.
That committee will hear at least two other bills opposed by nursing homes — one that would change the way nursing homes are paid by the state and another that would allow surveillance devices in rooms to monitor care.
Appel said he was disappointed by the failure of his bill, but he thinks his peers are delaying an inevitability.
“I don’t think there’s any possibility this won’t go into effect in the next couple years in some form,” he said. “The number of people becoming eligible for these types of services are growing astronomically, and the model of jamming people into an institution is just going to get more and more expensive. We’re not going to have a choice.”
Those voting in favor of Appel's bill were Sen. Dan Claitor, R-Baton Rouge, and Sen. Ed Price, D-Gonzales. Voting against SB357 were Sens. Gerald Boudreaux, D-Lafayette; Regina Barrow, D-Baton Rouge; Norby Chabert, R-Houma; Yvonne Colomb, D-Baton Rouge; Dale Erdey, R-Livingston; and Luneau.
Year after year, Louisiana lawmakers gather in Baton Rouge and grouse about the unpalatable choices they face: Cut state services, raise taxes or do some of both.
A team of government experts and industry stakeholders spent more than two years painstakingly crafting a plan that would have reduced Louisiana’s expensive and unpopular reliance on nursing homes to house the state’s most helpless residents.
The past 10 months have ticked away at a torturously slow pace for Kenny Johnson, who prayed every day he’d get the call telling him it was time to leave the nursing home.