Will Hartford fund Medicaid?

NORTH CANAAN — Just once, John Horstman would like to see a state budget proposal and not feel that a large segment of the population has been ignored. Just once, he would like not to have to contemplate how many nursing homes will have to close their doors because there isn’t more money for Medicaid.

For Horstman, who heads Geer Nursing and Rehabilitation Center in North Canaan, it’s about respect — or what he sees as a lack of respect for the senior population.

"These are the people who built our communities. Now they need taking care of, and they should get the respect and dignity they deserve," Horstman said in an interview with The Lakeville Journal.

The Geer administrator said he was shocked that Gov. M. Jodi Rell’s 2007-08 budget proposal offers no increases to Medicaid rates paid to nursing homes for the next two years.

Meanwhile, the cost of staying in business is rising dramatically. Every nursing home in the state has been affected, he said, including four in the Northwest Corner.

"Inflation applies across the board and includes things like clothing and furniture," Horstman told the Journal. "Our costs are for fuel oil and electricity and food, which has gone way up because of gas and the cost of delivery. Whatever inflation rates and cost of living increases you hear about, ours are probably much higher. We are already under-funded by Medicaid at about $14 per bed."

Horstman was one of about 300 people who attended a press conference at the Legislative Office Building in Hartford on March 21. The effort to urge budget-makers to rethink Medicaid reimbursements included seven nursing home residents who spoke about their personal plights.

"There was one lady with MS who spoke about losing her ability to walk, and then to use her arms, and how she will one day lose her eyesight," Horstman said. "But what she said she feared most was losing her home."

Following the press conference, a large contingent walked over to the State House and Gov. Rell’s office, where they delivered a petition with 10,000 signatures.

Horstman recalled a question asked of Toni Fatone, executive vice president of the Connecticut Association of Health Care Facilities (CAHCF).

"She was asked why we were targeting the governor when it’s up to the legislators to negotiate the budget. Her response was that nobody should have to negotiate for adequate funding for nursing homes. Well said."Cutbacks undermine the system

Meanwhile, nursing facilities are taking cost-saving measures.

Horstman said that staff wages at Geer have increased no more than 3 percent over the past five or six years. Geer has managed to hold the line to a great degree on health insurance costs for staff, while employees have been asked to contribute more. The only "give" left is to begin reducing staff, he noted.

"The only way to provide good, quality health care is with a good staff," Horstman said. "The whole system of long-term health care is being undermined."

In the past, the state’s answer to controlling costs has been to control growth. There has been a moratorium in place for 15 years now on adding more beds, despite a need that exceeds what is currently available.

At the local level, the answer to staying in business is to charge more to self-pay residents — those who don’t qualify for Medicaid — and short-term rehabilitation clients, which are costs that come under Medicare.

Why does the state regulate privately owned nursing homes?

"Because no one can afford to operate without subsidies," Horstman said.State shortchanged the industry

Workable solutions have come from the nursing home industry. For instance, two years ago, administrators successfully sought legislation for a "bed tax." By levying a tax on beds occupied by non-Medicaid clients, the state could tap $120 million in federal subsidies. It was a simple solution that could have taken care of the needs of existing nursing homes and assured more beds to meet the needs of the elderly population.

"The state, in its infinite wisdom, chose to give us only 60 percent," Horstman said. " They gave the rest of it to other state agencies and undermined the whole plan. There are funds those other agencies could be tapping that actually apply to them, but they seem happy to be using what we consider to be our funds."

What would satisfy needs is about a 4 percent increase in the nursing home reimbursements, or about $60 million. While that seems unlikely to come out of Rell’s proposed $35.8-billion budget, something would be better than nothing.

Horstman also said legislators could make things much easier with some long-range planning.

"Even five years of knowing what’s coming would be helpful, instead of having to fight for funding every year."

In a letter to the editor that appear in the March 8 edition of The Journal, Horstman urged residents to contact their legislators and ask them to "revere our elderly and protect them like the national treasures they are."