There is a fine balance – especially for non-profit, long-term care facilities – to stay in the black on the balance sheet while following core values, which often include taking care of our older adults who do not have the financial ability to “self-pay” for personal care or skilled nursing. Often, the discrepancy between what Medicaid reimburses and the cost to the facility does not encourage a great deal of advocacy on behalf of the facility itself. In Pennsylvania, our Governor would like that number to be increased or incentivized to encourage a larger percentage of bed usage from the Medicaid sector.
There are required quotas for state approved facilities.

Pennsylvania is a rapidly aging state: one in five residents is currently 60 years of age or older. By the year 2020, one in four Pennsylvanians will be age 60 or older. Two-thirds of nursing home residents are Medicaid patients, and the data show unreimbursed Medicaid costs in Pennsylvania will exceed $470 million this fiscal year. Dr. Stuart Shapiro, President and CEO of the Pennsylvania Health Care Association, is one of many sounding the alarm. He and Genesis HealthCare Vice President Paul McGuire joined Smart Talk a program sponsored by public radio station WITF in Harrisburg, PA – to talk about long-term care in the state.

Dating all the way back to 2001, when a comprehensive study of the Medicaid reimbursement system ‘s effect on the quality of long-term health care providers showed that an increase in Medicaid reimbursement improved quality as measured by professional staffing – the quandary over the necessary level of Medicaid reimbursement to nursing care facilities versus the level that incentivizes attention to improved care and a higher number of Medicaid admissions and lengths of stay – has been examined by our State and National lobbyists and legislators.

Just today, in the Bangor Daily News, lawmakers were reported to confront a difficult reality in the coming weeks: the state has been underpaying its [nursing homes] for years, and a bill pending before the Legislature’s Health and Human Services Committee would give them a needed raise….in 2011, MaineCare — Maine’s version of Medicaid — paid the [homes] $29.4 million less than it cost them to care for their residents. To make up the difference, the homes shift the charges to the minority of residents who pay for care from their own assets or whose bills are paid by Medicare.

For private, not-for-profit retirement communities and CCRC’s the incentive to admit long-term Medicaid patients or to keep those who may or may not need to be held in excess of a rehab stay – does not exist. Meeting the minimum requirement makes the most financial sense in a world where most revenues are reinvested in the care of self-pay residents. Accounting meets altruism, and the CEOs and Chair people of the Board are caught in between.

“If we could reach people earlier with some limited home and community-based services, we could delay more people going into facilities,” said Brenda Gallant, Executive Director of Maine’s long-term care Ombudsman program.

“Maine’s Nursing homes will always be an important component of long-term care. But services should be available for all those who want to and can remain safely in their homes, be it adult day programming or help from an in-home aide. For taxpayers, those services are substantially cheaper than nursing home care. The federal government has an interest in paying for them through Medicaid.”

No matter what your party affiliation, there is one dynamic affecting not only our manufacturers and services providers, but also our long-term care facilities. America is aging – and we – as product and service providers – have an obligation to address all areas of need, especially healthcare. Here at FieldGoals.US we specialize in 55+ older adult research – and partner with long-term care providers to ensure preparation for your 1-year, 5-year – and beyond – plans to reach the ever-changing face of our aging nation.