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If Florida has learned anything from its attempts to provide care to frail elderly residents, it is that there are no simple solutions. The needs, from warm meals to nursing homes to hospitalization, are as diverse as the various state and local agencies attempting to respond and the financing formulas by which the services are paid.
To his credit, then, Senate President Jim King told his colleagues Friday that a plan to suddenly begin handing over this job to HMOs is, at best, premature. He vowed to stop any major attempts to do so in the remaining two weeks of the legislative session, and lawmakers would be wise to listen.
No one should dispute the notion that services for the elderly need an overhaul, but that is precisely what the Legislature has been doing in recent years. It has created a policy office for long-term care, an aging and disability resource center, new standards for nursing homes, a nursing home transition program, and a nursing home diversion program.
The nursing home diversion program is a good example of why the change to HMOs is precipitous. The program is designed to try to help elderly residents avoid the nursing home by giving them help in their own homes. That's not only humane but it also saves on the state's soaring Medicaid budget, which is now roughly $2-billion a year on nursing home care. The problem, though, is that this program began only as a pilot last year, and the state is already seeing that the reimbursement rate is too high for the community groups and businesses that agreed to do the job.
Given such limited experience in the area that most directly bears on the business decisions HMOs would ultimately make with elderly patients, the state could not credibly hand over more this quickly. And Ed Towey, spokesman for the Florida Health Care Association, makes a reasonable point about the pressure these companies will face: "In the real world, the managed care company is going to go with the lowest prices. That may or may not bring the best quality. Likely it won't, because it can't."
Rich Morrison, chairman of a long-term care study commission the Legislature itself
created, says the state is in no position to hand over all Medicaid long-term care programs to HMOs. He warns that the same budgetary pressures that are hurting state agencies could have a disastrous effect with HMOs. "Once money runs out, will managed care be there?" he asks. "Or will you have destroyed the community infrastructure you need over the long run?"Do lawmakers not remember their experience with Family Continuity Programs, a nonprofit business that took over the job of caring for abused and neglected children four years ago in Pasco and Pinellas counties? Family Continuity is out of business, in part because the state kept cutting back on funding, leading the corporate headquarters to pull the plug. In this case, the Sarasota Family YMCA could quickly take over. If an HMO were to leave, who might be left to care for the elderly?