Elderly care has to be better

The Louisiana Nursing Home Association has been calling the shots at the state Legislature for too many years. The House Health and Welfare Committee last week again killed legislation aimed at giving the elderly and physically handicapped an opportunity to receive more private managed care at home or in community settings.

The Advocate in a recent series explained why nursing homes have such a firm grip on the legislative process. The newspaper reported that owners of nursing homes and their affiliates during the last decade have pumped about $6 million into state political campaigns.

The committee room where House Bill 152 by Rep. Tony Bacala, R-Prairieville, was heard was packed with nursing home representatives. They told the same old story during testimony about nursing homes getting a bad rap about their quality of care. And it came as no surprise when they insisted Bacala’s bill would result in limited care for the state’s oldest and most vulnerable population.

A review of the past demonstrates not much has changed in Louisiana since the mid-1990s. Louisiana was spending 92 percent of its Medicaid money on nursing homes at that time and only 8 percent elsewhere. By 2004, it was 82 percent to nursing homes and developmental centers and only 18 percent for home and community care settings.

The percentage going to nursing homes has currently dropped to 77 percent, not much progress in more than a dozen years. Meanwhile, the national average that was 67 percent of Medicaid money going to nursing homes in 2004 has dropped to 60 percent with 40 percent available for health care alternatives.

Jeanne Abadie of The Advocacy Center in New Orleans said, “People will die waiting for those (home-based) services.”

They don’t have to. The sad side of this story is the realization the situation could be much better. Former Gov. Bobby Jindal formed a task force during his last two years in office to study how the state could privatize oversight of long-term managed care in settings other than nursing homes.

A plan that cost $2.5 million to design and create was developed, but a request for proposals from private companies was abandoned by Jindal in the face of nursing home opposition. Bacala’s bill simply called for re-starting the process by seeking those proposals.

The Advocate in its series said Jindal topped the list of state officials with $774,468 in nursing home industry contributions.

Joe McPherson, a nursing home owner who served in the state Senate from 1984 to 1996 and from 2000 to 2012, has been a longtime spokesman for the industry. He said during testimony that most people in nursing homes are unable to be cared for in home and community settings because they are too dependent.

“If you can identify people in nursing homes who can live cheaper and better in their community, then we’ll help them out,” McPherson said. “They don’t exist.”

A United Health Foundation report said otherwise. It found that 14.2 percent of Louisiana nursing home residents are considered “low-care” and don’t require physical assistance for daily living. The Advocate reported that a U.S. Department of Justice investigation released in December found that many Louisiana nursing homes are failing to do their part to identify patients who want to transition back to their homes.

Why would they? What some agency or advocacy group should do is interview families of nursing home residents and actually determine how many of them could and want to  live successfully elsewhere. The numbers could be staggering.

An AARP survey found that 90 percent of people living in Louisiana would prefer to be cared for at home and by community-based support programs.

Stephanie Grace, a columnist for The Advocate, wrote about Kenny Johnson, who prayed every day for 10 months that he’d get a call telling him it was time to leave the nursing home. How many others like him are there?

OK, so where do we go from here?

Andrew Muhl, an AARP lobbyist, said, “We will continue to seek an answer from the governor and our Legislature on why they think Louisiana should continue a (health care) system that does not work for the 30,000 people currently waiting for services.”

Jindal dropped the ball, so Bacala says the next step is up to Gov. John Bel Edwards. The Advocate said Edwards supported the concept before his gubernatorial election, but now has serious reservations.

Richard Carbo, a spokesman for Edwards, told the newspaper the administration is reviewing its options to improve long-term care services for the elderly. However, he said it isn’t an easy task and not a silver bullet that will solve all the problems.

Carbo said, “We are going to continue to work with advocates and providers to find ways to improve the system.”

Edwards was in the No. 2 position on that nursing home contribution list with $720,309 funneled to his campaign war chest. A serious effort to increase the home and community-based care for older and handicapped citizens is the best way for Edwards to convince the skeptics that the campaign money won’t keep his administration from doing the right thing for the elderly and disabled of his state.

Having had personal experiences with nursing home care has convinced me the elderly should always have more choices when it comes to how they want to be treated in their golden years. Louisiana can and must do better for them than it has for much too long.

Jim Beam, the retired editor of the American Press, has covered people and politics for more than five decades. Contact him at 337-515-8871 or jbeam@americanpress.com.””

(Tunstall/MGNonline)

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