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Is Scaring Nursing Home Residents the Right Way to Run a State?

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By Steve Moran

It is just kind of a stupid way to run a government . . .

This is not particularly a shot at the state of Louisiana or even state government. After all, I live in California where doing crazy things is all but mandatory for the government.   

On Thursday and Friday of last week, the state of Louisiana sent letters to 37,000 recipients of Medicaid benefits in a number of different programs notifying them that in 60 days, those programs would run out of money and their services would stop. 17,000 of those residents are in nursing homes, in the neighborhood of 85% of the entire nursing home population of Louisiana.

Background

The state of Louisiana had two things happen:

  1. A $0.01 sales tax expired

  2. The state constitution only allows the state legislators to increase taxes every other year and this is not the year

And, as you can imagine, there is a lot of brinksmanship going on between the various political parties and factions in the healthcare system.   

Because of all this, the state is being forced to cut all kinds of services, but nursing home care is the scariest because mostly those residents have no place to go.   

Technically what is happening is that the maximum income qualification for Medicaid was reduced from $2,350 per month to $750 per month.  

The Politics

Here is a very brief overview of the politics . . .

  • While the constitution only allows taxes to be increased every other year, the governor can call a special session where they can increase revenue.  

  • Like most states, they have a relatively few budget items that are discretionary and the impacted Medicaid programs fall into that category.

  • There are a number of new Republican legislators that ran on a platform of reducing government spending. They are resisting the call for a special session and voting for additional taxes.

  • Because of the shortfall, various interest groups are lobbying hard with the government and the public media for a large piece of a little pie, including a free college education program (which seems to be faring better than nursing home residents).

Gross Stupidity

The nursing home industry has completely clean hands in this fight. They, their residents and team members are the victims of, if we are honest, a vitriolic political environment where both sides are playing to win without regard to collateral damage. The only goal here seems to be to make the other side look bad, without seeming to realize that both sides look terrible.

One cannot help but believe ageism is a big factor here.

Really Scary

This whole this is really scary on 3 levels:

  1. THE REALLY BIG SCARE: Right now, the politicos are all saying, “Don’t sweat it, we will get this fixed. No residents will be put out on the streets; no one will really be hurt." 

    I am willing to acknowledge that the highest probability is that they will fix the problem but what if they don’t?

    I look at DACA where president Trump rescinded Presidents Obama’s executive order. He assumed, reasonably, that since all the Democrats and many of the Republicans said they were committed to taking care of these young people, the Congress would act on the problem.   

    They didn’t because the hate for the other side of the political divide was way more important than solving a real problem.

    What if this same stubbornness happens in Louisiana over this issue? It is very scary and a very real possibility.

    I am worried that in 60 days the money will stop. This will hurt residents, team members, the whole economy and, if it bankrupts some nursing home operators, they will likely be gone forever.

  1. Just getting the letter will be a traumatic experience for residents and family members. It will take a great emotional toll on them. They will wonder what will happen, what they should do. I can’t help but believe it could hasten the death of some.

  1. It destabilizes the workforce at all levels. One of the things I most love about senior living is that it gives individuals who are on the bottom of the employment stack the opportunity to have a professional job and to, with hard work, grow into better jobs. At another level, we are beginning to see some serious efforts to hire fresh college graduates into our field.

    After looking at this, why would they bother?

Big Picture

More than anything else, this should be a siren call that AHCA and LeadingAge National, along with other stakeholders need to hold a summit and propose a new way of doing healthcare and serving seniors. There is enough money in this great country, but all we do is play piecemeal games where each faction is fighting for a disproportionate share of a pot of money that is not growing as fast as the needs are.

We can keep fighting fires and in taking that approach the fires will never stop popping up. A new bold plan is a way to create long-term stability.

We as a country should be better than this. As an industry, we have a unique opportunity to make it a better place for all.

A Big Thanks . . .

A big thanks to Wayne Plaisance, the CEO of Chateau De Notre Dame; KaraLe Causey, the CEO of Haven Nursing Center; and Karen Contrenchis, President of LeadingAge Gulf States for providing the background and color I needed to write this article, though all of the opinions are my own.

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