September 16, 2014
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Path of being told to deliver more for less must end

To the Editor:

Recently, a few facts floated across my desk that impact seniors all across Rhode Island.

First, it appears that Rhode Island finally ranks number one in something. According to the 2010 U.S. Census, our state has the highest percentage of citizens over the age of 85. Why? No one knows. Apparently we live longer and stay here for our really golden years. Whatever the reason, it appears that more of our citizens choose to grow old in Rhode Island than in any other state.

Second, a study recently released by the Center for Gerontology and Health Care Research at Brown University shows that Rhode Island’s nursing home population is more frail and dependent than ever before. One ties into the other. It’s easy to understand that as we age, the more intensive our health care needs become and as our 85+ population continues to grow, so too will the need for long-term care services.

What’s interesting is that it’s long been touted that Rhode Island’s long-term care Medicaid costs exceed that of other states. Policymakers have argued that these costs need to be brought into line with counterparts throughout the country. Unfortunately, the impact of Rhode Island’s large percentage of elderly over the age of 85 – those who use nursing home care the most – is commonly overlooked.

The results of the 2010 census and the Brown study come at a time when state officials are redesigning the payment system for nursing homes to an acuity-based system. Therefore, never has it been more important to have a clear understanding of two trends: the number of Rhode Island’s elderly needing the intensive services provided in nursing homes is disproportionately large compared to other states; and the role of the skilled nursing facility has changed over the years. No longer convalescent homes, today’s facilities have morphed into centers providing intensive short-term rehabilitation and recuperation following a hospital stay or long-term care for Rhode Islanders with chronic, medically complex conditions.

While assisted living and home care services are touted as less costly alternatives to nursing home care, in fact these valuable services are designed for different populations. Only nursing homes deliver the level of care needed by those requiring 24-hour nursing services. Robbing Peter to pay Paul, i.e., shifting funds from nursing home care to community-based care – is not the answer. The entire long-term care system needs to grow to reflect Rhode Island’s changing demographics.

Despite the legislature’s original intent to align payments to skilled nursing providers to the acuity of those they care for, there seems to be an inclination on the part of the Administration to develop a payment system that doesn’t account for the additional resources needed to care for a growing “old old” population. People in Rhode Island’s nursing homes require more staffing, more therapies, more medication and more resources than ever before, yet the funding for these services has been cut by millions of dollars in recent years.

Eventually the path of being told to deliver more with less has to end. Unless policymakers begin to realize the needs of Rhode Island’s demographics, we will continue to sell short the needs of our oldest generation. Currently, Rhode Island ranks among the top states in terms of quality care in nursing homes, according to nationally reported quality indicators. On January 1, when the new payment system is scheduled to go into effect, access and quality to nursing home services could change drastically. Seniors across the state should be aware of that.

Last year, our legislators asked for the development of a payment system based on meeting the growing needs of nursing home residents. It’s up to the Department of Human Services to deliver that system. In doing so, the Administration should be mindful that the care of our most frail and dependent population should never be compromised to balance the bottom line.

Joan M. Woods,
Chair, Rhode Island Health Care Association
Executive Administrator, Grand Islander Center, Genesis HealthCare


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