The State Department of Social Services will spend an estimated $1.2 million in 1988-89 to perform federally-mandated assessments of nursing home patients to make sure the facilities they are in meet their needs.
The money will be used by the Divisions of Mental Health, Handicapped Services and Aging. Because the assessments are a mandated part of Omnibus Reconciliation Act of 1987, federal Medicaid will match 75 percent of state costs.The act is intended to prevent persons with mental retardation and other related conditions that require active treatment (supervised activities, therapy and treatment) from being placed in inadequate nursing homes. It also ensures that those already in homes are receiving proper care.
Every state is required to review all nursing home residents and determine if they require active care. If patients require treatment and it's not available in their facility, the state has two options--transferring the patient to another facility or making the facility provide the care.
People needing active care who have been in a facility more than 30 months have the option of remaining in the home or being transferred to another facility. If they choose to remain in the home, the facility must provide the care.
Residents requiring active care who have been in a facility less than 30 months will be automatically transferred to an active care institution. People in facilities who don't require nursing facility care or active treatment will be discharged. Community and home failities that provide adequate active treatment can receive a waiver and active treatment patients can be transferred there.
The act requires that the state complete its assessments by 1990 and update them each year. The assessments must follow federal guidelines, which have yet to be distributed. Until the guidelines are released, exact costs of the assessments are unavailable. However, it's estimated that they will cost about $500 to $800 per person.
"The assessment costs, in the other states that are doing this, have ranged from $200 to $2,000 per person depending on the type of assessment. We estimate that our assessment should cost about $500 to $600 per person," said Gary Nakao, Division of Services to the Handicapped director.
The division estimates that it will spend approximately $150,000 to $180,000 for its assessments. Nakao said the division plans to have a complete proposal within six months.
The Division of Mental Health will have a tougher time. The division needs to evaluate about 800 people, at an extimated cost of about $700 per person. In addition, 130 more people are expected to enter nursing homes this year.
"We've never had to do assessments before and unlike a lot of other divisions, we don't have an assessments team," said Keith Stroud, division director.
In addition, Stroud said there are no alternative treatment facilities offering active care for mentally ill patients other than the state hospital. "It is our belief that the state hospital is too restrictive, so alternative centers will have to be created." Such centers can cost up to $75 a day, and unlike handicapped services, home and community waiver facilities are not available.
"The intent of the bill is to give patients needing active care the proper treatment. It's a good bill, people have a right to proper treatment, but it's a big budget issue." Stroud said. "It puts tremendous pressure on the state . It's a fiscal impact we're not prepared for."
Nursing home residents who are not mentally ill or handicapped will also be affected by the act. The act tightens nursing home care and treatment standards, requires that a licensed practitioner nurse be available 24 hours a day, and that nurses' aides pass a federal training program.