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State continues to meet challenge of caring for our elderly

Readers of your editorial The unkindest cut (May 30) may have been misled by the absence of certain key facts about how nursing homes are paid by Florida's Medicaid program. Payments to nursing homes are cost-based, and each year the amount Medicaid pays goes up as costs increase. The annual increase going into effect as of July 1 amounts to 6.4 percent - a rate that would seem generous to most Floridians if it was applied to their salaries.

Since my first year in office, the average payment for each nursing home resident has grown from approximately $30,000 per year to more than $53,000. That change constitutes an increase of 77 percent in the eight-year period.

It's true we have instituted some controls on these increases to manage escalating costs. These controls act as incentives for greater efficiency and counterbalance the inflationary tendency of cost-based reimbursement. It is important to note the cost controls are applied to administrative expenses while allowing more flexibility to reimburse costs related to direct patient care. Ninety percent of all nursing homes are reimbursed 100 percent of their nursing care costs.

The real challenge before us is not to accelerate the growth in nursing home expenditures, but to change the way we care for seniors - supporting them in their homes and avoiding placement in institutions whenever possible. This transformation will lead to better outcomes for our seniors as well as lower cost for our system. I remain committed to working toward this goal, and look forward to working with our long-term care providers to make it happen.

Jeb Bush, governor, Tallahassee

 Restore these critical funds

Floridians need to be distressed that in his final months as Florida's governor, Jeb Bush vetoed more than $91-million from the Medicaid nursing home program. The governor's comment in striking this money from the Legislature's approved budget was that those caring for the frailest, most at-risk institutionalized elderly do not really need the money.

As the CEO of one of a handful of Florida's "Gold Seal" nursing homes, I wish the governor had taken a few minutes to talk with us, or any other high-quality Florida nursing home, and ask why we needed these funds. Over the last six months, Florida legislators certainly made the effort to examine nursing home needs, and they determined that adequate funding was essential to sustaining high-quality care.

Over the last five years, Florida has been steadily increasing the statutory requirements for nursing home staffing and programs. And through our membership in the not-for-profit Florida Association of Homes for the Aged, we joined with other interested stakeholders in helping to raise these standards. Throughout these years, Gov. Bush supported these endeavors; indeed his administration took credit for most of them. But in a field that is so very labor-intensive, increases in staffing standards and programs invariably result in increased costs - mostly in additional labor. It is these increased program costs that drove the overwhelming need for the $91-million that this governor has just vetoed. And so the governor now plays a carnival shell game by telling us that he has increased funding for additional nursing assistants - while at the same time reducing funding for everything else, including licensed nurses, social workers, electricity and food.

Responsibility for addressing this crisis must now return to the Legislature for resolution, and so we ask our elected representatives to now come back to Tallahassee and restore these critical funds to the Florida Medicaid budget. The 3-million elderly residing in the state of Florida deserve no less.

Martin A. Goetz, chief executive officer, River Garden Hebrew Home for the Aged, Jacksonville

One for the pooches

Re: Dogs may dine too, June 3

Well, hurray for our side! Gov. Jeb Bush finally signed a bill I agree with. I am currently not a dog owner, although if I ever do own a dog, it is nice to know that we can share each other's company while dining together at an outdoor cafe.

And that's a mighty cute picture of the governor shown in the Times. He looks like a real "woofer." Oops, excuse me, I was looking at Sen. Charlie Clary's darling little Yorkie Dixie Cup. Well, I guess the governor doesn't look too bad either.

JoAnn Lee Frank, Clearwater

Sinkhole situation smells rotten

Re: Sinkhole payouts creating a crisis? May 29.

I would like to thank Garrett Therolf for the well researched and informative article on how people are profiting on sinkhole insurance payouts in Pinellas, Hillsborough, Pasco and Hernando counties: nine claims for $300,000 in 2002; 582 claims for $63.4-million in 2005. That is about 65 times as many claims, 211 times more money in just three years. This is what journalism should look like.

These data should be shouted from the rooftop, until the Legislature and or the governor admit that something smells rotten in the business/legal communities. Do politicians in a democracy always have to be extremely slow to respond, always give the benefit of the doubt to business and professional establishments over the common folk who are being shafted?

I guess the first rule is to remember friends, i.e. the ones who butter their bread.

Stephen J. Halasz, Spring Hill

There are more risks to cut

Re: Allstate drops quake policies, June 3.

I find it hard to believe that a large nationwide insurance company can pick and choose whom it would like to insure. If this is the case:

Grocery owners should stop allowing elderly customers into their stores. They can slip and get hurt, and besides most of them can't afford to buy much with their fixed incomes.

Hospitals should keep out heart attack, stroke and accident victims. The odds of surviving aren't the best.

Department stores should make sure people earn above the poverty level to enter their store. More money could be spent that way.

Health insurance companies should deny coverage to women of childbearing age. They would save a lot of money on prenatal care and delivery.

Less intelligent or underachieving students should not be permitted in school. That would be a great way to improve FCAT scores.

One last thought: If all the insurance companies drop coverage in areas with natural disasters, the remaining areas will have many companies competing for their business. With such a large supply of insurance companies, the areas without natural disasters should be able to get really good deals. Then how will insurance companies survive?

A. Randall, St. Petersburg

Too much hurricane gloom and doom

In all the years I have lived in Florida, this is the first year that the hurricane season has been announced so fervently throughout the media. Hurricanes are a way of life. Do we need to hear it constantly? Between that, and your paper's coverage of insurance hikes or cancellations, you are making the Tampa Bay area sound like a horrible place to live.

Negative press is causing so many markets to suffer. Just because we saw the devastation of Katrina does not mean we need to hear about current predicted weather for the next six months. People need to be aware and take responsibility for their own actions. If they have not learned by now to be prepared, shame on them. But frankly, I don't want to hear about it throughout the day. Let us thank God for what we do have and how beautiful it is instead of playing negative sound bites.

Betty O'Hearn-Hines, Treasure Island

[Last modified June 6, 2006, 12:45:01]