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Stuck
in a nursing home By Jim
Siegel, Advocate
Diana
Munkres has a sharp mind, even if
her
body has failed her a few times over the years. She
can remember exact dates of events from five years ago. She speaks proudly
of the colorful afghans that she creates and donates to a local pregnancy
center. But
life is not as it should be for the 60-year-old. Munkres
-- who relies on a wheelchair due to an amputated left foot and problems
with the right -- wheels herself down the hallway to her tiny room, which
she shares with an ever-changing roommate, some of whom have stolen her
things or trashed the place. Along
the way, she passes other residents, many of whom suffer from Alzheimer's,
dementia, or some other loss of mental capacity. At
night, the hallways are often filled with yelling, loud televisions and
other noises that keep her awake. "I
really have no friends there," she says between sips of coffee at a
restaurant near the Like
others in Munkres
is much better suited for an assisted-living facility, with its increased
privacy, social activity and independence. But considering her string of
health problems that followed the loss of her job, she certainly can't
afford the approximately $3,000 a month to live there. Despite
repeated requests from advocates for the elderly, and more recently Gov.
Bob Taft, state lawmakers have yet to allow Medicaid to cover
assisted-living costs for low-income seniors. "I
think we need to let consumers control more of the money," said
Barbara Edwards, state Medicaid director. Betty
Thompson, elder rights resources director for the District 5 Area Agency
on Aging, said she sees some residents failing because of the lack of
stimulation provided by a nursing home environment. "You
will get people who come into a nursing home who feel they can do better
somewhere else, but sometimes there is no somewhere else," she said. Progress
made; Gap remains State
lawmakers have made strides in providing options for low-income seniors,
with significant funding increases to the Passport home-care program. But
advocates for the elderly say the system still contains a glaring hole. Ohioans
who can afford it are choosing a less-restrictive environment, but some
low-income seniors on Medicaid are forced into nursing homes, said Kathy
Tefft-Keller, state director for AARP Ohio. "We
would most like to see choice in long-term care that puts the consumer in
the driver's seat," she said. An
AARP report in 2002 noted that more than one-third of Passport clients who
leave the program end up in a nursing home, after they outpace the
system's ability to care for them at home. This, the report said, shows
the need for assisted living to fill that gap. Robert
Applebaum, a long-term care expert from the To
be eligible for Passport, Applebaum argues, a person not only has to be
very disabled but also nearly destitute, with less than $1,500 in assets,
not counting a home. He
said the state could raise that limit to the $5,000 federal limit. Fight
for change Tefft-Keller
said the AARP has been fighting to get Medicaid coverage of assisted
living since the mid-1980s. In addition to running into a formidable
nursing home lobby, lawmakers have struggled with other issues. "One
of the biggest challenges is finding a clear understanding of what
assisted living is, Tefft-Keller said. "The philosophy is 180 degrees
to nursing home care." The
general concept of assisted living is a facility with private rooms, where
workers and nursing staff tend to the residents daily needs, such as
cooking, cleaning and part-time nursing care. Otherwise, for the most
part, folks are on their own. But
that's boiling it down to the basics. The state doesn't have an actual
definition, so a wide range of facilities today are calling themselves
assisted living. Gov.
Bob Taft has pushed for at least a pilot program of Medicaid-funded
assisted living. Greg Moody, Taft's top adviser on health and human
services issues, said the state doesn't pay for assisted living, so it
doesn't really regulate it. "If
we would pay for it, we would have to know a little better what we were
paying for," he said. That
means auditing, licensure and more oversight, likely in the form of
inspections. It's
those regulations that worry Jean Thompson, executive director of the Ohio
Assisted Living Association. Thompson
thinks Medicaid payment for assisted living would fill a "huge
hole" in long-term care by easing the jump from home care, such as
Passport, to 24-hour skilled nursing care at a nursing home. But
she doesn't want the state clamping down on them with a bunch of new rules
and regulations. "We
support (Medicaid payment) as long as the criteria offers adequate
reimbursement and does not change assisted living by adding so much
regulation that that what were getting funding for isn't assisted living
anymore," Thompson said. Seniors
and woodworking But
an even bigger concern for lawmakers is the uncertainty over what it would
cost to add assisted living facilities to an already bloated Medicaid
budget. "It's
just trying to convince lots of people it's not another potentially
open-ended funding process where once the state gets involved in it, it
can't keep up with the funding," said Sen. Bill Harris, R-Ashland,
chairman of the Senate Finance Committee. "There
is a (service) gap. But where do you stop the obligation of the family
member and pass that onto the government?" A
year in assisted living can cost about $100 a day, about 36 percent less
than the $57,000 annual cost for a nursing home stay. Sen.
Eric Fingerhut, D-Cleveland, has unsuccessfully pushed legislation for
Medicaid-funded assisted living. He
doesn't believe it will cost more, and he points to the growing Passport
program as proof that costs did not shoot upward because the state decided
to expand a home-care service. "Providing
the least restrictive option for the Medicaid caseload is also the least
expensive option," he said. Others
disagree, citing the woodworking effect. As the theory goes, the state
agrees to pay for a new service, and suddenly people come out of the
woodwork to take advantage of it. "If
you've got 50,000 people in assisted living, and all of a sudden the
government is going to pay for it, they'll say, 'Gee, Ill take some of
that,'" said Mike Compton, director of government relations for AOPHA,
which represents nonprofit nursing homes. "Once you give people
something, you can't take it away." Tough
opposition The
two major groups representing for-profit nursing homes, the Ohio Health
Care Association and the Ohio Academy of Nursing Homes, oppose Medicaid
payments for assisted living. Peter
Van Runkle, president of the Health Care Association, called it
unnecessary, saying the assisted living industry is doing fine right now.
He also said some of his members who own assisted living facilities don't
want the additional regulation. Norman
Dreyer, president of the Ohio Academy of Nursing Homes, is concerned that
more seniors who are less sick will leave nursing homes for assisted
living, leaving homes stuck with the sickest, most expensive residents. He
said some of his members report that assisted living facilities are doing
heavy recruiting to draw residents from nursing homes. "Therefore,
they are in effect, drawing some nursing home clientele that should be in
nursing homes, and they're doing it on private pay dollars," Dreyer
said. As
for Diana Munkres, she's one of those hoping Medicaid can step in and pay
for assisted living. Concerned
that she'll never handle the financial requirements of home-based care,
she sees herself spending the remaining 20 or 30 years of her life in a
nursing home. "My mind is
perfect," she said. "But I could end up like them (the other
residents) very easily if I didn't keep myself busy."
Copyright
© 2002 Global Action on Aging |
