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My view: Unintended consequences for elderly

By Faye Lincoln

Published: Thursday, Nov. 1 2012 12:00 a.m. MDT

Michelle Christensen, R.N. and Barbara Crebs sign a national petition to stop federal medicare cuts at Crosslands Rehab and Health Care skilled nursing facility on May15, 2002.

Laura Seitz, Deseret News

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The growing baby boomer generation is not only seriously concerned about juggling family responsibilities along with their own health care needs, but also about the challenges of caring for aging parents. Today's economic and public policy woes not only bring stress to many families, but are also creating unintended consequences for providing care to our elderly.

For those who are unable to safely care for themselves, many families will seek to provide support in the home. Sometimes this is done with the help of formal caregivers from the community. Over time, some families will become exhausted and 24-hour nursing care becomes a necessity.

A skilled nursing facility may then be very appropriate, either on a short- or long-term basis. When this happens, everyone wants care to be compassionate and holistic in nature, focusing as much on the patient as the families who are involved. It is always expected that the care is of a quality level which serves the frailest of our elderly.

For such expectations, the average national rate paid to nursing homes in 2011 under Medicaid is equal to $7.17 per hour over a 24-hour period of time; less than the national minimum wage, according to published statistics by the American Health Care Association. This includes room and board, nursing care, medication administration, physician-ordered treatments and physical therapy services. They provide meals and snacks, a full activity calendar, transportation services and a high level of social interaction with others.

When 24-hour care is required, nursing care facilities are still the safest, most economical answer for the right situation. Yet, today's public policies are seriously eroding the foundation of this noble industry whose employees are dedicated to caring for our most vulnerable. We see government policymakers significantly reducing the funds which pay for this quality care.

Cutting social program costs by cutting rates is usually an easy answer to our country's budget challenges. But the long range outcome is to see nursing homes de-stabilize around the country. Such facilities do not want to reduce their quality of care, so many will decide they can no longer afford to provide care at all. Several health care policy dominoes are leading to this outcome.

Over 63 percent of the patients in nursing homes nationally in 2010 were paid through state Medicaid programs on a long-term basis. As the economy has slowed, states have continued to cut rates which support such nursing care communities.

Medicare rates have also been cut to facilities in late 2011 by an average 11 to 12 percent and further cuts are being projected. While only an average of 14.2 percent of patients were paid for by Medicare in 2010, these funds help to stabilize a facility's rates so they can provide care to sicker patients on a short-term basis.

As we appropriately keep people more independent either in their homes or in assisted living settings, this reduces the number of people who require skilled nursing home care. This shift inadvertently drives up daily costs while payment rates no longer adequately cover the cost of care.

The policies under the new Affordable Care Act which will govern future health insurance will be the last domino to de-stabilize the industry. Many facilities will no longer be able to afford to provide health insurance to their employees as the cost is not adequately covered by current rates.

So who will be harmed in the end by this? Our most vulnerable elderly who are simply in need of 24-hour care when they can no longer remain safely in their homes. Long-standing nursing facilities will no longer be able to support patient and family needs if they close. Jobs will be lost in large and small communities alike. Or the quality of care will ultimately be impacted through poor policy choices. This is the unintended consequence of health care policies today.

Faye Lincoln is a senior vice president at Avalon Health Care, Inc.

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