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NH Scorecard

BY RICHARD L. PECK, EDITOR-IN-CHIEF

Nursing Homes/Long Term Care Management asked readers to give Washington’s policymakers letter grades on several key issues

Probably no industry in the country receives as much public criticism as long-term care (not even the press!). So what fun it is to put the shoe on the other foot and have the long-term care field judge others-in this case, federal policymakers in Washington, D.C. This magazine took a few days in late summer to run a quick e-mail poll of readers, asking them to grade Washington’s leaders-from the President and Congress to professional associations to (yes) the press-on how well they’ve performed with regard to issues of critical importance to long-term care. The results were-well, let’s say they weren’t pretty. Our sampling of readers responded with letter grades (from A to F, with F for “failing”) and, in many cases, wrote brief commentaries. What follows are the letter grades that predominated numerically for each type of leader under each long-term care topic.

MEDICAID REIMBURSEMENT
Our poll was taken at a time when Congress had yet to act to restore Medicaid funding increases that had lapsed this June and the President’s budget was calling for cuts.
President: D
U.S. Senate: F
Your senator: D
U.S. House: C
Your representative: D
AHCA: C
AAHSA: C
Centers for Medicare and Medicaid Services (CMS): D
The media: F

Selected Comments
“More and more requirements, but no dollars to assist in making it a reality. Lawsuits as a result of the most minor of infractions. No more dollars to assist in making quality of care a reality.”

“When is the last time the government actually looked at the cost of medical equipment?”

“I have been a nursing home administrator for 30 years, and I have never seen such a lack of concern for our elderly and disabled. We are underfunded by $14 per patient day…. We want to provide quality care, but quality costs $ and everything goes to insurance, licensing, energy-HELP!”

“I believe an owner should be able to make a profit…but only a reasonable profit. The staff need to be paid fairly, and most of the money should go for quality care and services.”

TORT REFORM
This long-debated issue that cuts across all of healthcare has been described as all but politically dead for long-term care this year.
President: F
U.S. Senate: F
Your senator: F
U.S. House: F
Your representative: F
AHCA: C
AAHSA: C
CMS: F
The media: F

Selected Comments
“Unrealistic expectations of what it takes to take care of human beings who have reverted back to infancy. Unrealistic expectations that we can control what a noncompliant resident wants. Negative outcomes are all about the facility, not about noncompliant families and/or residents.”

“We are such a punitive society. The solution to our problems is not lawsuits but working together to get the problems solved.”

“[Politicians are] afraid to address this because of fear of loss of interest group donations. Senators hide behind ‘consumer protection,’ but it’s really the money that talks.”

“Family members and residents who have been happy with care still seem to sue after going home. Advertising by attorneys, in print, television, and radio, continues to bombard consumers.”

“The rise in liability insurance rates continues for this nursing facility, even though we have had no losses from lawsuits.”

MEDICARE PPS REIMBURSEMENT
Our poll was taken at a time when CMS had preserved a $1.2 billion add-on and promised a 2.8% increase for next year.
President: D
U.S. Senate: D
Your senator: D
U.S. House: D
Your representative: D
AHCA: C
AAHSA: C
CMS: C
The media: F

Selected Comments
“Someone needs to look into the discrepancy in reimbursement rates between critical access hospitals and SNF for patients receiving benefits under Medicare Part A. Our local hospital averages about $500 per day reimbursement for a resident on swing-bed (Medicare Part A). As a SNF with the same resident being skilled (Medicare Part A), we are reimbursed about $250 per day. Medicare should require swing-bed patients to be transferred to a SNF for rehabilitation when there is a bed available. This could be a significant cost savings….”

“High-acuity patients are not fully reimbursed. Using the MDS is a big mistake. The ‘feds’ have turned caregivers into bookkeepers.”

“I think that these elderly people who have done nothing wrong except get old don’t deserve to be treated like second-class citizens by the government. People in prison get better treatment than the elderly.”

“Medicare, with all its faults, is still our best payer. The willingness to maintain enhanced rates is a real positive.”

“PPS laws/interpretations have become so burdensome and confusing that they are almost impossible to implement without threat of fraud.”

“The PPS system is extremely cumber-some, takes many nursing home hours to complete, and takes away from the time that could be spent actually caring for our elders.”

OBRA SURVEY REFORM
At poll time, state surveys remained a contentious issue, described by opposing camps as either “too bureaucratic and punitive” or “too weakly enforced and possibly corrupt.” No significant change in the status of OBRA surveys seemed on the horizon.
President: F
U.S. Senate: F
Your senator: F
U.S. House: F
Your representative: F
AHCA: C
AAHSA: C
CMS: F
The media: F

Selected Comments
“Hospitals don’t have to meet the infection control, cleanliness, documentation, nursing, staff training, and quality-of-life standards that nursing homes routinely are surveyed against. Nor do hospitals have a state or federal agency whose role it is to police their actions. Yet more skin conditions, infections, and abuse occur at the hands of hospital staff than at nursing homes. No one is their watchdog-why?”

“We still have negative surveyors with unrealistic expectations. The laws have unrealistic expectations. We cannot keep people from failing during their elder years.”

“The media only wants to blast the ‘bad’ and, of course, the government listens to the media. So we have a vicious circle.”

“Those who fail to fund quality care should share in the results of underfunding.”

“I believe the surveys are a good thing to keep healthcare workers up to the level of care that these elderly people deserve. But I think that the media is not telling the whole truth…they tell only the bad things. Bad things go on the front page….”

“Does not encourage quality care, but rewards mindless standardization.”

“Instead of looking for outcomes, continues to place great emphasis on paperwork.”

“I am a director of nursing and feel like much of my time is spent ensuring that we are ‘paperwork-ready for survey.’ It leaves me little time to actually work on processes and implement change in the facility. It would make more sense to survey LTC the way JCAHO surveys hospitals, with a compliance rating in percentages.”

“A primary problem with this process is that each surveyor has an opinion, and we are often surveyed more by opinion than by actual regulation.”

PRIVATE LONG-TERM CARE INSURANCE
Congress has for several years considered giving long-term care insurance above-the-line tax deductibility and, more recently, expanding Medicaid/private insurance “partnerships” in the states. No action had yet been taken as of press time.
President: F
U.S. Senate: F
Your senator: D and F (equally high number of responses)
U.S. House: F
Your representative: F
AHCA: C
AAHSA: C
CMS: F
The media: F

Selected Comments
“Too expensive and only for the top-income bracket. Regular, average taxpayers have to hope they will die before they need long-term care.”

“Most people can’t afford to raise a family and think about the future and pay for long-term care insurance. Why do we pay all these taxes and still have to worry about long-term care?”

“Without closing the loopholes for Medicaid qualification (transfer of assets), where is the incentive?”

“Don’t see much of this at all. Families say it is too expensive for people on a fixed income.”

“Like all insurance, needs to be affordable. We must continue to find ways to provide incentives to individuals and families to purchase and maintain LTC insurance, which in the long term will provide relief for ‘social entitlement’ programs.”

“When attorneys are not suing us, they are advising clients on how to ‘protect assets.'”

“There still seem to be people who have this insurance and really do not know what the benefits are. People selling these policies need to be very specific and make sure the client understands the benefits and restrictions.”

LONG-TERM CARE FINANCING REFORM
No serious federal initiative has emerged since Rep. Claude Pepper’s proposal to create a “Medicare Part C” for long-term care in 1990.
President: F
U.S. Senate: F
Your Senator: F
U.S. House: F
Your Representative: F
AHCA: C
AAHSA: C
CMS: F
The Media: F

Selected Comments
“We need to take care of the reimbursement problem today. Let’s take care of our elderly. The system is not fair, and the welfare of our country is at risk.”

“You people up in your high, fancy offices have no idea what these elderly people put up with to try and make ends meet and pay for medical care. If you can finance wars and help other countries, why can’t you finance the people in our country who need help and have paid taxes all their lives? How would you feel if these people were your parents and someone like you, probably with no medical training, arbitrarily decided they didn’t need a medicine or treatment and therefore decided there would be no financial coverage? I think this system is unfair to medical professionals and facilities who, at times, provide the care at their own expense so that the patient doesn’t have to do without.”

“I don’t hear about it! “

Conclusion
Our thanks to those readers who took time during their busy days to grade Washington’s policymakers. A couple of observations: In those areas in which Washington has taken some type of action during the last several years-specifically, Medicaid and Medicare reimbursement-readers’ responses tended to be relatively more positive, if still unenthusiastic; at least they gave credit for trying. Second, of all these leadership categories, the professional associations seem to come out on top in readers’ estimation; again, maybe it’s the sense that someone is at least trying on their behalf. Still and all, Washington has received some very poor grades here-an overall failing grade, it would be fair to say. No doubt many political issues are in play during this election year. Even among our readers, issues such as the economy, the war in Iraq, culture wars, and legislative morality may weigh more heavily than professional concerns in their voting decisions. Boiling things down strictly to long-term care, though, this could be one report card for which poor performers won’t be asked to repeat the year.

To comment on this article, please send e-mail to 2peck1004@nursinghomesmagazine.com. For reprints in quantities of 100 or more, call (866) 377-6454.

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