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Published: Sunday, 4/10/2011

Budget hurts frail elderly

BY PETER VAN RUNKLE

Gov. John Kasich's proposed state budget is bad for Ohio's frail elderly population. We are not talking about people who can stay at home with a little help. We are talking about the sickest of the sick.

These Ohioans require health care in skilled nursing facilities, because their care needs have become too great to allow them to stay at home and their families no longer can bear the burden. They have had surgery or an acute injury or illness, and need intensive rehabilitation.

The governor's budget proposes to cut their care dramatically. He seeks to slash $472 million in state payments to skilled nursing facilities over the next two years.

Mr. Kasich says he wants to allow "Mom and Dad" to stay at home where they are more comfortable, with caregivers coming in as needed. That is the way it should be — whenever possible.

Everyone would prefer to stay at home. If a person just needs some government-paid help at home, that is cheaper than going to a skilled nursing facility where round-the-clock care is the norm.

But while provisions in the governor's budget encourage home care, the massive cut to skilled nursing care would do nothing to help people stay at home. It simply drains resources for caring for the sickest of the sick, who need to be in skilled nursing facilities — Ohioans who temporarily or permanently cannot stay at home.

Plagued by long-stagnant reimbursement rates, Ohio's Medicaid program already pays skilled nursing facilities $15 a day less than the cost of a typical patient's care, according to a recent national study. Because 70 percent of the cost of operating a skilled nursing facility goes to personnel, the proposed reimbursement cuts inevitably will result in job losses — more than 7,000 across the state by our estimates.

These jobs are held by productive, taxpaying citizens. Without employment at a skilled nursing facility, many of these workers likely will end up on public assistance themselves.

Even more important, these jobs are held by caregivers. If the proposed cuts become reality, there will be fewer sets of hands to care for our frail elders. They will suffer.

Call lights will not be answered as quickly. Patients will not get medication as soon as they need it. They will not be turned and repositioned as often. Their basic care will be delayed, and significant, measurable quality improvements that Ohio's skilled nursing facilities have achieved will be reversed.

The Kasich administration says that Ohio has too many skilled nursing facilities, and that some of them should close. Officials in Columbus point to vacancy rates in counties around the state.

But these vacancies do not cost the state a dime. Medicaid pays only for care delivered to people who need to be in a skilled nursing facility. The proposed method of closing such facilities — bankrupting some by cutting reimbursement to all — will hurt all skilled nursing patients in the state.

Abruptly evicting frail elders from a skilled nursing facility is traumatic and can lead to death. It is by no means clear that skilled nursing facilities need to close. But if they do, there have to be more thoughtful, compassionate ways to do so — perhaps a process modeled on the federal military base-closing commission.

Governor Kasich has made much of his administration's efforts to "transform" Ohio's health care system, and many changes are in store. But not all transformations are good.

That is the case with his plans for skilled nursing care. We must rely on the General Assembly to reverse the governor's dangerous proposal.

Peter Van Runkle is executive director of the Ohio Health Care Association, which represents more than 700 skilled nursing facilities, assisted-living communities, and other providers of long-term care.



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