The Legislative Budget Committee's recent decision to reject federal Money Follows the Person dollars is not only baffling but an affront to nursing home residents and their families. By providing federally subsidized home care, the money would have allowed many elderly people to stay in the comfort of their own homes rather than being forced to move to nursing homes. It would have been a victory for their dignity and a savings for taxpayers.
But the state has turned it down. It is becoming more and more difficult to understand what Florida policymakers are doing to help safeguard nursing home residents.
First, the Legislature and Gov. Rick Scott approved a budget that slashed Medicaid dollars needed for resident care and reduced direct care staffing hours by 18 minutes per resident per day — a dramatic decrease for residents who rely on complete support from caregivers.
The Gerontologist, an academic journal focused on aging issues, recently completed a three-year staffing study on quality of care in nursing homes and concluded that there is a correlation between staffing and quality care. Their results confirmed, "Higher certified nursing assistant staffing levels were predictors of lower total deficiency scores and quality of care deficiency scores." Now the real irony: The research team used Florida data for its analysis.
These results come as no surprise for residents, families, advocates and consumers who have espoused for years that quality nursing home care is dependent upon a robust number of well-trained caregivers able to meet residents' needs.
Second, the federal government appropriated more than $2 billion for the Money Follows the Person initiative through the Affordable Care Act so nursing home residents who receive Medicaid have the option to choose where they want to live — either in a nursing home, an assisted living facility or at home with assistance.
Since 2005, 43 states and the District of Columbia have engaged in a variety of demonstration projects, making the initiative renowned for maximizing service options to consumers. The program allows for long-term care to be transformed from a provider-driven to a "person-centered" model. This runs against the grain of Florida's proposed Medicaid managed care plan that would force residents into health management organizations with fewer options.
As the state long-term care ombudsman for most of the past decade, I visited and interviewed hundreds of nursing home residents across Florida. The overwhelming sentiment from residents when asked about their living arrangements is that residents wanted to go home.
Now the federal government wants to write us a sizable check — $35.7 million — to support further development, but our "elected representatives" have decided to say "no thanks, we don't need the help." They claim that funding will be solvent only through 2016, forcing the state to pick up the tab afterward. While that may be the case, there is an option to apply for unused federal dollars that could be used until 2020. Their decision essentially crushes the hopes of hundreds, maybe thousands, of nursing home residents who aspire to seek health care outside of a nursing home.
But what our state gave up is more than just the $35.7 million; it also surrendered a considerable amount of unrealized Medicaid savings. The annual median cost of Florida nursing home care is $76,777. At an assisted living facility it is $31,950, and home health care averages around $40,000 per year. So for every one resident in a nursing home, essentially two could be receiving care in a less restrictive environment.
Taxpayer savings coupled with a higher quality of life for residents — the Money Follows the Person plan appears to be a win-win for everyone.
But whenever there is a winner there is a loser, and the losers in this deal could be the nursing home industry and the insurance companies. Collection revenue for nursing homes could suffer from lower occupancy rates, and the select insurance companies privy to be a part of the managed care group would encounter additional competition from alternative care options for residents. This would be a good thing for consumers as it drives down costs and boosts service delivery.
So the Legislative Budget Committee, the Legislature and the governor should reconsider that decision and accept the funds, perhaps using these savings to restore staffing ratios in nursing homes and preserving quality care.
Brian Lee is executive director of Families for Better Care, a citizen advocacy organization dedicated to quality nursing home care.