As the region’s population ages and rural nursing homes are squeezed between rising costs and declining revenue, a growing number of public nursing homes are being forced to close. Consider this snapshot from Eastern Washington’s Okanagan Valley ...
Nearly half the public nursing homes in rural areas of Washington have closed since 2007. Prosser. Davenport. Garfield County. Odessa.
Tonasket’s North Valley Nursing Home could be next on the list.
CEO Linda Michelle says the problem is simple: “Expenses rise, and if reimbursements don’t rise with it, you go in the hole.” Stay in the hole long enough, and the hospital operating alongside the nursing home could be in jeopardy as well, Michelle says.
State governments squeezed by the recession have also been shouldering an increasing share of healthcare costs through Medicaid. Americans over 85 are the fastest-growing segment of the population, and states have been hard-pressed keep up with the costs of care for the elderly. Nationwide, a recent study found a shortfall of nearly $8 billion a year in states’ Medicaid reimbursements to nursing homes.
Private facilities can stem their losses by capping the number of Medicaid beds and requiring higher-paying private insurance for the rest. Public nursing homes don’t have that luxury.
“We can’t say to you 'because you’re on Medicaid we don’t have a Medicaid bed for you,'" Michelle says.
At North Valley, 90% of residents pay with Medicaid. Giving a tour of the cafeteria and Bingo room, Dyral Coleman says today is a “good day” -- 4 days a week, his doctor prescribes brandy along with breakfast.
Coleman moved into the nursing home two years ago. He used to live in North Valley’s assisted living wing, but it closed because of similar financial woes. At 90, he says change is hard, even for the little things.
“I finally got ‘em to put a slice of onion in my hamburgers,” he says, a request that took two years to stick.
Resident Care Manager Sandy Vaughan says other displaced residents fared much worse.
“We had people who moved from the assisted living over to here who physically became worse, who were emotionally challenged,” Vaughan says, recalling one resident who cried for days after changing rooms.
“We had one resident who died shortly after the move, because it was just too much of a change," Vaughan says.
Now, some residents fear the nursing home could go the way of assisted living.
One problem is that as medical costs have grown, billing and accounting have become more complicated too. Staff at small rural nursing homes have had trouble keeping up.
“You can buy technical expertise, potentially,” says Gary Kelso, but... “They may not, in many cases, have a budget to do it.”
Kelso is CEO of Mission Health, a non-profit nursing home operator in Utah. He says technical expertise is crucial in getting the best possible rate for the care provided.
Medicaid doesn’t pay for everything. Instead, each facility’s reimbursement rate is based on hundreds of factors that add up to determine the “acuity” of each case. “Are they receiving restorative therapy? Are they receiving certain narcotics that require a nurse to manage it?” If not, he says, the reimbursement is bound to be lower.
That doesn’t necessarily mean less work: take a person who’s wheelchair-bound, or someone with dementia.
“It may be very heavy staff time, you know, to make sure they’re safe and comfortable, but it’s not sophisticated in the acuity sense,” Kelso says.
Kelso specializes in rescuing small public nursing homes in financial distress. He says facilities like North Valley have a hard time keeping costs down. Wages and benefits may be higher than in the private sector, and many homes are over-staffed. Often, being tied to a hospital also means paying more for food and medical supplies.
Because hospitals typically have higher overhead, Kelso says, “if they’re sharing the costs, they’re passing the cost on to the nursing center, based on that cost basis.”
Nationally, nursing homes are consolidating to achieve economies of scale, or being replaced by less expensive home and community-based care. But neither remedy will save public nursing homes in rural areas. If North Valley closes, the nearest open Medicaid bed could be more than an hour away.
Copyright 2015 Northwest News Network
