In response to the May 31 letter by Joe Donchess, executive director of the Louisiana Nursing Home Association, I would like to make a few points about why disability advocates would like to see managed long-term services and supports implemented in Louisiana.

Last year, Louisiana spent about 74 percent of its long-term care budget on nursing home care and only 26 percent on home and community-based services. This indicates a woefully unbalanced long-term care system, especially when 35,000 people continue to wait for services that they prefer to have provided in their homes. Implementing managed long-term services and supports does not shift money from nursing homes to community-based services, but it provides more flexibility in choice of services and therefore improves access to in-home care.

Managed-care organizations have the authority to provide people with home and community-based services, which is less expensive than the nursing home alternative. Currently, it costs Medicaid about $25,000 per year to assist someone to live in the community, while it costs about $47,000 per year to serve someone in a nursing home. As stated earlier, implementing managed long-term services and supports can help balance the system, but more importantly, it is a way to provide the services that people want. To paraphrase state Rep. Walt Leger, who spoke in support of House Bill 790: I don’t know anyone who says that they can’t wait to go into a nursing home.

People suffering from Lou Gehrig’s disease, or ALS, are living longer, and something we believe will be an even greater need for our patients will be long-term care. Long-term care choices that will meet each and every person exactly where they are most comfortable, living with this disease.

In addition, managed long-term services and supports are a mechanism to promote quality in nursing homes, as well as in home and community-based services. I do not understand why Mr. Donchess would oppose a system that can improve Louisiana’s health rankings for all seniors and people with disabilities. Currently, of Louisiana’s 280 nursing homes, 49 percent have a one- or two-star ranking out of the five- star ranking system. Only 10 percent of Louisiana’s nursing homes have a 5-star rating, which puts Louisiana second-to-last nationally in this category. People in Louisiana who need long-term care services deserve a system that will incentivize quality rather than a system that tolerates poor quality.

Managed care has been shown to improve quality and choice for people who require long-term care. Louisiana’s current long-term care system does neither. It is time for a change, and it is time that Louisiana listens to the 35,000 people who want to remain at home to receive their services and stop listening to self-interested provider groups.

Kelly Viator

executive director, ALS Association LA-MS Chapter

Baton Rouge