Taking Care of Our Care Providers

Every year about this time, citizens from all across the state come to the Capitol to inform and educate their Legislators.  These citizen lobbyists are so critical to our democratic process.  They provide insight necessary to make wise public policy decisions.  As Marcia Avner puts it, “Public policy is the set of decisions that we make as a society about how we will care for one another, our communities and the land.”

A couple weeks ago, farmers filled the Capitol halls.  Last Wednesday was Nursing Home Advocacy Day.  If ever we need to make wise policy decisions about the way we care for one another, it is how we care for our elderly and disabled.

I had the opportunity to meet with Nursing Home Administrators from around the state including our Senate District.  They talked about being paid well below their costs by the state’s Medicaid program and, as a result, about wanting to improve buildings and upgrade facilities and not being able; about wanting to pay their workers more and not being able.

Nearly 4,000 people in our Senate District work in nursing homes. Most of these dedicated workers provide direct care to some of our most vulnerable citizens.  My first job was providing care to nursing home residents. I know this work is very rewarding but I also understand the hours are longer and the job is getting harder.  Residents are sicker and require more care.  And resources are much tighter. 

For forty-five years, low-income, elderly Americans have depended on Medicaid – the state health program for low-income people - to pay nursing home bills. Nearly two thirds of all nursing home residents are Medicaid recipients. The federal and state government has made a commitment to fund nursing home care. This is not likely to change. But what changes are the rates paid for care in our nursing homes.

For the second year in a row a national study of Medicaid payments to nursing homes ranked Wisconsin as dead last. The study compared the rates paid to nursing homes with their allowable actual costs. In 2009, Wisconsin fell two hundred million shy of covering allowable costs to our four hundred nursing homes. This translates to daily losses of twice the national average or about $40 dollars a day per Medicaid resident.

The gap between costs and Medicaid payment continues to grow. And the state’s financial problem has made more fragile the financial situation of many nursing homes.

This translates to difficulties in finding and keeping good staff and problems in maintaining and upgrading buildings. Add in residents who need more care than years ago and our nursing homes are struggling to survive.

Many administrators are forced to raise rates to those who are private pay residents. State-wide, nursing home administrators estimate private pay patients pay $70 more than Medicaid residents despite receiving the same care.

Wisconsin has seen a steady decline in the number of homes and beds. Sixty-five homes have closed in the past eleven years. As facilities close, families have fewer options close to home.

In the past ten years efforts have been underway to help elderly citizens who can live at home to stay at home. While nursing homes care for the sickest and most fragile, the Family Care program provides in-home services and coordinates care which helps keep people in their homes and communities. 

The Family Care program is expanding beyond cities to cover many rural areas. But rising costs have many Legislators concerned about the future of Family Care.

As the state struggles now to provide care to our elderly, all of us are aging, increasing the pressure on an already fragile system. If we are lucky we will have a comfortable retirement and good health.  But should we need good, quality affordable nursing home care, we must take care of our care providers.