There has been a lot of press coverage lately about inadequate nursing home funding.
During this discussion, there has been occasional mention we should care for our elderly at home with home care services instead of at nursing homes. No one will deny “there’s no place like home,” and it usually costs less to stay there. What’s not apparent to the general public is that there is a limit on what services you can provide in the home. The majority of people who reside in Maine nursing homes typically cannot be cared for in their homes.
Twenty years ago, in 1994, Maine’s Medicaid program changed the rules regarding whom it would pay for in Maine’s nursing homes. Only the sickest of the elderly would be paid for in a nursing home, and the healthier elderly would need to move back home or to an assisted living facility. As a result, Maine’s supply of nursing home beds went from well over 10,000 beds down to 7,000 beds.
Assisted living facilities and home care expanded services to meet the new demand. The 1994 change put Maine ahead of the nation in restricting nursing home care to only the sickest of the sick.
Several years ago, Maine Department of Health and Human Services embarked on a new program known as “ Homeward Bound.” This program encourages and enables nursing home residents to move back home with home services. In the past three years, an average of nine people per year, out of 7,000 nursing home residents, have moved back home with this program’s help. This shows there are not many people inappropriately placed in Maine’s nursing homes.
Home care agencies and nursing homes care for two very different populations. Presuming all elderly’s health care needs are the same is similar to thinking a pickup truck can carry the same load as a tractor trailer.
Last summer, I served as a member of the commission that studied why rural nursing homes were closing. The short answer is lack of money.
We determined Maine’s nursing homes needed at least $30 million per year of additional funding to break even financially. Maine needs to provide $13.8 million per year of the $30 million, with the balance being matched by the federal Medicaid program. My understanding is that as of this writing, Maine still needs to come up with another $5 million to meet the full need.
Although the money that has been allocated is very much appreciated, it is not yet enough. The industry has been losing tens of millions of dollars per year for nearly a decade, and the financially disadvantaged providers now need to close up shop.
The closure of a nursing home is a very traumatic event. It displaces residents from their “home” and community, forces families to travel greater distances to visit, eliminates good jobs and decreases municipal revenues. Maine’s hospitals also were underpaid for the past decade. Their funding system enabled the amount of underpayment to be tracked, and they have been repaid. Unfortunately, Maine’s nursing home payment system has not tracked nursing home underpayments, and the more than $150 million of underpayment will never be repaid.
While Maine was underpaying its nursing homes over the past decade, it simultaneously was providing thousands of young people with Medicaid health care services for free. I’m happy to see the recent efforts to reverse those trends are taking hold.
By increasing payments to nursing homes, more jobs will be created that can take young people off welfare and enable them to earn their own living. This transition is not over yet. More money than is allocated is needed to prevent more nursing home closures. Let’s take care of our elderly. We owe it to them.
Phil Cyr has managed the Caribou Rehab and Nursing Center for 28 years. He also managed the Visiting Nurses of Aroostook for 8½ years.