Phase out nursing homes, state board says
Rehab, home care would replace traditional sites
By DAN BENSON
Milwaukee Journal-Sentinel, July 17, 2003
The traditional nursing home - where frail,
but not necessarily seriously ill residents live for years under the
watchful eyes of floor nurses and their assistants - should be phased out, a
state board has told Gov. Jim Doyle and state lawmakers.
"It would appear that the zenith of this
form of residential long-term care has been reached," George Potaracke,
executive director of the state's Board on Aging and Long Term Care, wrote
to Doyle and legislators earlier this month in a letter accompanying a
report containing a number of recommendations on long-term care reform.
The board also suggests that the state look
into investing in a long-term care insurance fund and more closely regulate
out-of-state companies that wish to operate retirement facilities in
Wisconsin.
If enacted, the recommendations would
represent the culmination of a national trend spearheaded by Wisconsin 20
years ago and largely watched by other states, officials said.
"The traditional nursing home we've known
for years will either change and become a true rehab center or it won't
exist at all," Potaracke said Thursday.
That's because ever-tightening government
budgets coupled with an array of market forces make it fiscally untenable to
support the traditional nursing home, he and others say.
"Those that will need true long-term
support will be living in smaller group homes, supportive apartment
arrangements or at home," he said.
For those currently living in traditional
nursing homes, such as the Ozaukee County-run Lasata Care Center in the Town
of Cedarburg: "Some of those people would never wind up in a nursing
home to begin with" under the plan envisioned by Potaracke and the
state Board on Aging and Long Term Care, which grades nursing homes.
And it wouldn't just be publicly operated
nursing homes that would be affected.
If the board's recommendations are adopted,
Medicaid payments for long-term residential care at private nursing homes
could be cut to encourage people to use in-home medical services and other
alternatives.
Only those able to foot the entire bill
themselves would be able to live in the types of nursing homes with which we
are now familiar, officials said.
Any state funding, the report recommends,
should more directly link funding to the quality of care provided in nursing
homes - lower inspection grades would have a negative impact on funding.
"Is it appropriate to adopt a policy that
would encourage that kind of evolution?" asked Judith Frye, associate
administrator for the state's Division of Disability and Elder Services.
It's a key question that will be addressed by
a new Council for Long Term Care Reform, the creation of which is expected
to be announced in a few days, Frye said.
"The thought would be that if that seems
an appropriate policy then we would restructure the reimbursement mechanism
and not continue to pay for long-term care for those people who don't need
that care," she said.
"Since this is the department that pays
for a lot of nursing home care through the Medicaid program, it's important
that we address that kind of care," Frye said.
Potaracke, who has headed the aging board for
22 years, said the report is "a continuation of a discussion that's
been going on for more than 20 years."
"This is in response to market forces and
government policies that have been moving for a long time," he said.
"What's different now is that for the
first time these issues have been brought together in one paper" and
will be addressed by the new council, he said.
Milwaukee County made the exact decisions
about 20 years ago that the aging board is recommending today, said James
Hill, Milwaukee County's interim administrator for the Behavioral Health
Division.
Through his division, the county operates two
long-term care facilities for people suffering from persistent mental health
problems and for those with developmental disabilities.
"We've been oriented toward that type of
care for some time, focusing on the least-restrictive care setting,"
including in-home care for the elderly, he said.
"We believe it's fiscally the right thing
to do and most beneficial to the client," he said.
It's a model for more traditional nursing
homes, Potaracke said.
The state should "refocus nursing home
care toward rehabilitation and subacute care in all but specified
circumstances such as dementia, brain injury and terminal illness," he
wrote.
Subacute care is typically applied to those
who need a short period of intensive therapy but not full hospital care,
"people recovering from surgery or a stroke" and whose stay in a
nursing home is a matter of weeks or months at most, Potaracke said.
A final recommendation is that the state
"should have more intimate knowledge" of the private corporations
that operate nursing homes in Wisconsin.
Doing so, Potaracke said, might prevent what
happened in Milwaukee County in 2000 and 2001 when Atlanta-based Mariner
Post-Acute Network went into Chapter 11 bankruptcy and closed two nursing
homes.
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2002 Global Action on Aging
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