A Bush Medicaid cut could leave nursing home patients who have to be hospitalized.
By STEPHEN NOHLGREN
Published March 1, 2004
Grace Potaski's home is tiny by any standard. She lives in St. Petersburg's Bon Secours nursing home, Room 428A, the half next to the door. A blue curtain separates her from a roommate.
Still, it's her space. It encompasses her television, her Renoir print, her corkboard of family photographs. It's where familiar faces help her to bed at night.
But she could lose this place the next time a brief illness sends her to the hospital overnight, under a budget cut proposed by Gov. Jeb Bush.
The touches of home would be stuffed in boxes and a bag and sent with her to the hospital because under Bush's plan, Medicaid would stop paying to hold open the bed of a nursing home patient who spends a night in the hospital.
Currently, residents can be hospitalized up to eight days and Medicaid will pay the nursing home to keep their beds open. After their hospital treatment, residents return to their corkboards and wall prints.
Medicaid calls this the "eight-day bed-hold." Bush proposes saving $23-million this year by eliminating it. In dollar terms, the bed-hold proposal pales beside a total of $300-million Bush hopes to cut from this year's nursing home budget. Florida spends more than $2-billion each year on nursing home care through Medicaid.
In personal terms, territory is at stake.
"What we'll have to do is send their personal belongings with them (to the hospital)," said Jim Rice, who runs Taylor Care Center in Jacksonville. "We'll have to have boxes for their toiletries and bags for their clothes and when the ambulance transports them, we'll just have to send that stuff with them, because we will fill that bed before they can come back."
Like many Florida homes, Taylor Care runs close to full capacity, sometimes with a waiting list. Run by a not-for-profit foundation, the home struggles to break even. If he can't fill every bed, Rice said, Taylor Care cannot survive.
"We have people who have been with us for 10 years," Rice said. "Now all of a sudden we are going to say, "You're off to the hospital, goodbye. If we happen to have a bed available when you come back, fine. If not, you just have to go somewhere else.' "
Bush's budget reflects his determination to tame Medicaid costs anywhere he can. A federal-state health program designed for the poor, Medicaid covers children without insurance, disabled people and frail elders. But its price has doubled in six years, driven mostly by drug and nursing home costs. Medicaid now consumes one-quarter of Florida's budget, the largest single expense.
Earlier this month, Bush told the St. Petersburg Times he plans to ask the federal government to let Florida cap Medicaid spending and design programs with fewer federal regulations. A cap would allow the state to deny Medicaid to people who are now eligible - a fundamental shift that would permit the state to spend whatever it chooses.
"It's a problem we have to deal with," Bush said last week. "We can't just sit back and allow the budget to grow by 12 or 15 per cent."
Medicaid's growth endangers the state's ability to finance other things such as education, Bush said, including "the class size amendment, which we have an obligation to do."
Besides the eight-day bed-hold, Bush hopes to cut $260-million from the nursing home budget by suspending payments for staffing increases mandated by the 2002 Legislature.
About $60-million of that proposed cut represents money for future hires. The other $200-million represents reimbursement for new nurses and aides already hired.
That's because Medicaid reimburses nursing homes based on the previous year's costs. To comply with that 2002 law, the industry already will have spent the $200-million by the time the new budget goes into effect. Reneging on reimbursement may put Bush on a collision course with some lawmakers, who undoubtedly will be pressured by local nursing home operators to maintain that funding.
A joint House-Senate committee studying nursing home issues will oppose any reduction in payments for staffing levels, said co-chair Dennis Jones, a Republican senator from Seminole. The committee is scheduled to vote on its final report today.
"Everyone has said that increased staffing has had a very positive effect on the quality of care and reducing litigation," Jones said. "We can't start going backward."
The committee also wants Medicaid to keep paying for the bed-hold, Jones said, though maybe at less than the full daily rate.
"When the patient goes to the hospital, the sheets don't have to be cleaned, the patient doesn't have to be fed three times a day," he said. "There ought to be less reimbursement."
Medicaid is the love/hate behemoth of nursing home finance. It pays the bills for two-thirds of Florida's patients but covers only bare costs, if that.
The Bush budget cuts would cost the average nursing home more than $400,000. Administrators said they will have to cut food service, activities, housekeeping and maintenance.
And without the eight-day bed-hold, they will fill beds when residents go to the hospital.
"As callous as it sounds, you can't pay bills if the bed is empty," said Jacqueline Hurt, administrator of The Home Association in Tampa's Ybor Heights, a 105-year home listed on the national register of historic places.
Catering to low-income, mostly African-American residents, The Home Association runs near full capacity all year, Hurt said. Medicaid pays for four residents out of five. Eliminating the bed-hold will mean longer hospitalizations, Hurt said, because it takes time to round up new homes.
"It's chasing pennies and losing dollars," she said.
To qualify for bed-hold money, a nursing home must have filled at least 80 percent of its beds in the previous quarter. That means the bed-hold cut would fall hardest on residents of the most popular homes. Bon Secours, where Grace Potaski lives, often has a waiting list.
Potaski, 86, was a baker at Dixie Hollins High School and the General Electric plant in mid Pinellas. A weak heart and lungs sent her to Bon Secours three years ago. She sits on the resident council, plays bingo and attends a weekly cooking class.
In January, she dodged a bed-hold bullet.
Most nursing home residents who get hospitalized return within eight days. Terrible breathing problems put Potaski into Northside Hospital for 13.
On Day 10, Bon Secours' admissions office called Jo Ann Drysdale, Potaski's daughter.
"The lady said, "I hate this part of my job, but I have to tell you that Medicaid only holds beds for eight days,' " Drysdale recalled.
The nursing home would keep the bed open if Potaski's family would pay the $146-a-day charge. Drysdale and her husband are both disabled.
"I said I couldn't afford that," Drysdale said. "They said they would have to pack up her belongings and put them in storage."
Good fortune intervened. When the hospital released Potaski three days later, her bed had not been filled.
Without Medicaid's bed-hold money, such uncertainties will become common, said Bon Secours social worker Nancy Reinthaler. It would also aggravate another phenomenon:
"We have people who simply refuse to go to the hospital for fear they won't get their bed back."
- Staff writer Joni James contributed to this report.
