Thursday January 11, 2001
The Center for Long-Term Care Financing's most recent report, "The LTC Triathlon: Long-Term Care's Race for Survival" (published on 12/7/00 in .pdf format at www.centerltc.com/pubs/recent.htm) is now available in hardcopy from the Center. The report is free to media and lawmakers. The cost is $49.95 for others and bulk discounts are available. Contact the Center at firstname.lastname@example.org with your order or for more information.
on interviews with 119 of the leading private financiers, providers and
insurers of long-term care, The LTC Triathlon study is a penetrating analysis
and critique of long-term care public policy.
(See the full press release announcing publication of the report at www.centerltc.org/triathlon_release.htm.) Don't assume, however, the opinions and insights of the largest
LTC players covered in the report are necessarily related to the scale of their
organizations. Smaller players are
facing some of the very same challenges!
In the Winter 2001 issue of Meadowbrook Ripplings, the newsletter of the Meadowbrook Extended Care Center in Seattle, WA, administrator and editor Virginia Sternberg identifies (in her column reprinted below) one of the most important and repeated themes of the Triathlon report findings. Namely, insufficient government reimbursement (via Medicare and Medicaid) threatens providers' ability to offer quality care and, in some cases, even their existence. Sternberg points out, as well, the benefit of having more private pay residents (who pay the full market rate for their care) to counteract the negative impact of below market government
As to Sternberg's point that state and federal governments must do more for Medicaid recipients, we agree. But improving the program for the benefit of the truly needy won't happen (especially as Medicaid budgets around the country are now being squeezed by higher costs and growing enrollment) unless and until the vast majority of Americans plan ahead with insurance or otherwise and avoid Medicaid. This is the only way the Medicaid programs can survive and even flourish to provide high quality care to those most in need.
Absent public policy reform that motivates people to plan ahead, however, Ms. Sternberg and her fellow providers will continue on a perilous course—for them and for us. The Center offers it's LTC Triathlon report in an effort to foster progress in the right direction.
Here's Ms. Sternberg in her own words:
"An Important Message to Our New President Elect George W. Bush:
"Our Federal and State Leaders Must Learn More About the Economics of Caregiving
"Everyone's attention has been focused on nursing homes and their inability to meet the quality of care needs of the elderly who require their services. Instead we need to focus on our state and federal governments and their responsibilities to meet the needs of the elderly--namely, the Medicare and Medicaid recipients who depend on the federal and state governments for funding.
"Show me the skilled nursing facilities (SNFs) that are having a crisis with quality of care issues, and I will show you that these facilities are the very same facilities that have a high population of Medicaid (welfare) recipients. Moreover, these are the same facilities that bought into upgrading their rehabilitation services by going into debt to better serve the Medicare population. The government then pulled the rug out from under them and reduced the reimbursements—the Prospective Payment System (PPS), even though the Medicare recipients were going to receive better trained, better equipped facilities. These kinds of economics do not work. When a business upgrades, they do so with the expectation of receiving either the same revenue and perhaps, hopefully, even more. What business would ever go into debt to upgrade with the expectation of receiving less?
"The federal and state governments blame the SNF operators, but those of us close to this industry know where the problem is. You will not find a SNF with a higher percentage of private pay customers doing very little Medicare business going bankrupt, like many have these past two years. Now what does this tell you? The government can spend all the money they want on determining staffing ratios, they can have all the committee meeting they want, but the buck stops there. The bottom line is: the governments (federal/state) do not pay their fair share.
"What's more, and what is even more unfair, the private pay are actually subsidizing the Medicaid (welfare) and more recently some of the Medicare recipients. Some smart consumers go so far as to call around to find out what a facility's private pay/Medicaid ratio is because they know the higher the Medicaid ratio, the poorer the care.
"If we are going to continue to mix the private pay with the Medicaid (welfare) and the Medicare recipients, then efforts should be in the direction of making it equitable for all. Our federal and state leaders need to learn more about the costs of caregiving."
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