Proper Care Takes Skill & Funding

VHCA (5/14/2010)

By Stephen Morrisette (Richmond Times-Dispatch 5/12/2010)

In the midst of National Nursing Home Week, May 9-15, it is important to recognize the elderly and disabled members of our communities who depend on quality skilled nursing care, and to do all we can to call attention to the vital need for stable funding for long-term care in Virginia and across America. Skilled nursing facilities are an essential part of our health care delivery system. Caregivers in these settings provide around-the-clock, life-sustaining care and services for Virginia's most frail and elderly individuals when they can no longer care for themselves or receive care in the home environment.

Today, approximately three out of every four patients' care is funded by Medicare or Medicaid, making the stability of these government programs essential to ensuring that patients have access to a variety of services nursing facilities provide today, including post-acute, rehabilitative, and long-term, skilled nursing care. Without stable funding, the ability of nursing facilities across our state to continue to implement quality improvements, integrate new programs, and expand care services to meet the needs of patients will be greatly hindered.

The Commonwealth of Virginia is facing a worsening Medicare and Medicaid funding squeeze due to recent cuts on both the state and federal levels, which will only be further tightened by new cuts to Medicare-funded nursing home care as part of the recent health reform legislation passed by Congress.

On the state level, 62 percent of patients treated in Virginia's post-acute and skilled nursing facilities are Medicaid enrollees. Nationally, Medicaid funds the nursing care of nearly 1.7 million Americans a year, making it the largest payer of long-term-care services in the United States. Without Medicaid, these patients would not have access to appropriate medical care. However, these seniors are facing a serious and worsening problem as the future of this vital state program appears uncertain.

Virginia's Medicaid program currently underfunds nursing home care by approximately $52.7 million annually, equaling nearly $4.7 billion nationally. This shortfall illustrates the massive discrepancy between what long-term-care providers are being reimbursed and the actual cost of providing quality nursing home care, including 24-hour skilled nursing care, three meals per day, medical supplies, and essential care services for grooming, personal care, bathing, and other activities.

For years, the federal Medicare program has "cross-subsidized" Medicaid -- meaning that it helps fill in the gaps where the state Medicaid rate does not adequately cover the actual costs of skilled nursing care. While the long-term-care community has historically depended on Medicare funding to prop up underfunded state Medicaid programs, deep Medicare cuts in reform legislation and regulatory instability weaken the financial support provided on a federal level.

Today, Virginia's nursing homes are providing care to more medically complex populations than we have in the past, including increased levels of short-term patients seeking post-acute care following a hip replacement or stroke. Once rehabilitated, many of these patients return home as active members of their communities.

Because of our vital role in the continuum of care, protecting funding for the care needs of Virginia's most vulnerable constituents -- the poor, elderly, and disabled -- and the front-line caregivers who care for them must be a priority.

This week, as we celebrate the patients we serve and the valued caregivers who provide high-quality care, let us also remember how important adequate, stable, and consistent funding is to ensuring the continued provision of quality nursing home care for all Virginia residents.