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Care for Elderly Caught in Legal Bind
By Norma Love, The Associated Press
June 20, 2005
For months, Health and Human Services Commissioner John Stephen has fought to keep more frail, elderly out of nursing homes.
But the home health agencies the state needs to make it work are locked in a legal battle with Stephen and the state over money.
The agencies say they can't survive on the state's pay - about 50 cents for every $1 of their cost to bathe clients, dress wounds, prepare meals, shop for groceries and provide other support needed to keep their charges healthy and safe in their homes.
In April, the Home Care Association of New Hampshire sued the state on behalf of its 38 members to get the state to abide by a law requiring it to pay them more. They said their members lost more than $5.5 million last year serving clients of Medicaid, state-federal health care for the poor and disabled.
Stephen's answer was to ask lawmakers to suspend the law and - at the same time - expand the number of elderly cared for at home. Stephen says he's caught between a law that requires him to pay higher rates and a Legislature that doesn't give him enough money to do it.
The Senate agreed to suspend the law, which pegs reimbursements to average costs, and to eliminate a 4.6 percent rate increase because the issue is in court. Both issues are part of budget deliberations.
The increase would help, but would not be enough to satisfy the law, the home care agencies contend.
Sen. Chuck Morse, chairman of the Finance Committee, said the conflict predates Stephen.
"I don't care what commissioner is over there," he said Tuesday. "They've been faced with this for years."
Stephen continues to negotiate with agencies while state lawyers try to have their lawsuit dismissed.
"You have competing issues. You have a methodology in the statute that says one thing and you have a budget appropriation that says another," Stephen said. "You can't have it both ways because you put the department in the position of having to defend lawsuits. In the end, the budget prevails, so we've wasted all this time and energy when we should be working together in unison for a very worthy common cause."
But Susan Young, executive director of the association, said her members are frustrated at their needs being set aside for years. Their last rate increase, in 1999, was the first in a decade.
Low state payments have forced the agencies to turn to fundraisers, charity and communities to cover some costs.
The Homemakers' Visiting Nurse Services in Strafford County holds a golf tournament, makes calls and conducts penny auctions to raise money. People buy raffle tickets and put them into coffee cans for a chance to win donated items.
The agency provides homemaker and companion services to about 800 people.
"We could survive without the state if we didn't service these folks. We have chosen to respond to this need," says Claudette Boutin, the agency's head.
It costs the agency $128 per hour to send a nurse to a home. The state pays $76.
Similarly, it costs $20.50 per hour for a homemaker to do minor household chores. The state pays the agency $14 to $16.
"The commissioner says, 'We don't have the money so let's just erase that law off the books,'" Boutin said. "It's amazing how these decisions are made that affect our citizens and employees.
"We're not taken seriously, like we're a bunch of nurses. You'll take care of the masses. You'll have more bake sales and car washes. We need some clout here. We need some political respect."
If the state doesn't pay more, Boutin will be forced to trim services. She had been relying on higher reimbursements for Medicare clients to help absorb Medicaid losses, but Medicare is cutting its reimbursements, she said.
The question will come down to whether a person can be cared for at home with twice-a-week services versus three or four times, she said.
Linda Hotchkiss, executive director of Your VNA in Rochester, is in the same dilemma. Her agency - like Boutin's - has been slowly using its limited savings to cover its Medicaid losses.
Your VNA also tries to find outside money. It sent 16,000 solicitations this year and got 200 donations. It also holds a silent auction and recently hired a comedian to perform at a fundraiser.
Without relief from the state, Hotchkiss said the agency may have to curtail services. Nursing takes priority over homemaking help, which some visiting nurse agencies have dropped as too costly, she said.
"You have got to take care of the wounds," she said.
Last year, Your VNA homemakers made more than 5,400 home visits. Hotchkiss worries about what will happen to frail people home alone if Your VNA drops that service.
"They'll not only end up in nursing homes, they'll end up in the emergency room," she predicts. "There are not nursing home beds in Strafford County. They need us. We are an important part of keeping them home."
Separately, some Medicaid clients served by home health agencies are about to have their eligibility for Medicaid eliminated or reduced. The proposed changes, reported by The Associated Press last week, would require some to spend some of their savings to continue receiving services. Others would need to pay some of their medical bills - in effect, pay a deductible - before the government would help them with the rest.
Hotchkiss said she pleaded her case for higher state reimbursements to then-Gov. Craig Benson, who told her Stephen would fix it. But even with a new governor, nothing has changed.
"I'm frustrated the state's not listening," she said. "I met with Benson and asked him how long he would build a widget for $1 and get paid 50 cents. They expect us to build it for $1 and get paid 50 cents."
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