450 Rally at Capitol for Long-Term Care

HARRISBURG — Carmella Yesavage has seen firsthand the challenges that Pennsylvania nursing homes face because of chronic underfunding. Her late husband was a resident at ManorCare-Pottsville for several years by the time she joined him there before his passing. She’s still at ManorCare-Pottsville, where she’s president of its Resident Council — and she’s still active, working to ensure facilities like hers get the funding they need to ensure high-quality care to those who need it most.

The 81-year-old Yesavage was among 450 nursing home residents, family members, caregivers, nurses and administrators who rallied in the Capitol Rotunda in Harrisburg on Wednesday to push for additional Medicaid funding in the 2016-17 General Fund budget for nursing homes.

“I’m here in Harrisburg today to tell our representatives and senators that we need increased funding for our nursing homes,” said Yesavage, a ManorCare resident for the last four years. “We need to protect and provide for our most fragile, frail citizens who reside in the skilled nursing facilities across our state. Those of us in nursing homes need our legislators to fight for us, and for the hardworking people who take care of us.”

The Pennsylvania Health Care Association is seeking a 3.5 percent increase — or $63 million in state funds that would earn a $68 million federal match — and continuation of a Medicaid access add-on for facilities that take care of the state’s most vulnerable residents. The $16 million “add-on” appropriation would generate $17 million in federal funds.

“Pennsylvania needs to figure out how we’re going to ensure continued quality care for our growing senior population,” PHCA President and CEO W. Russell McDaid said. “The only way to do that is to ensure nursing homes receive the financial support they need to provide high-quality services. Today’s nursing home resident requires a much more intensive and expensive level of care. Many of our facilities simply can’t sustain these services at the current funding rates.”

Nursing homes today are more like hospitals, with the acuity (sickness) level of residents continuing to increase. Pennsylvania’s 700-plus nursing homes care for more than 81,000 frail elderly and disabled residents who need around-the-clock support for clinically complex medical conditions, including debilitating afflictions such as dementia or Alzheimer’s disease. The end result is higher operating costs.

While long-term care costs have increased dramatically, funding for Medicaid residents has not kept pace. Roughly two-thirds of all nursing home residents rely on Medicaid. However, based on current Medicaid reimbursement levels, nursing homes are paid over $25.43 per day less than their actual costs of providing care. That’s a funding shortfall of $9,300 annually, on average, for every Medicaid resident in their care.

A new independent study by Avalere Health, a respected Washington, D.C. research company focused on health care, reports that nursing homes have seen their margins drop by 28 percent between 2007 and 2014, from 3.2 percent to 2.3 percent. Those margins dip even lower, from 1.4 percent to 1.2 percent, for facilities where 75 percent or more of residents in care rely on Medicaid.

“Between chronic funding shortfalls and rising health-care and operating costs, skilled nursing facilities simply cannot invest in necessary capital improvements or advanced technology that would enhance care, nor can they pay competitive wages that would increase staff retention, which is so vital to high-quality care,” ManorCare-Pottsville Administrator Dan Daub said.

At the same time, the need for long-term care is growing. Pennsylvania’s population is aging rapidly —  the commonwealth has the fourth largest population of people older than 85 in the United States — and that means significant fiscal and social challenges need to be addressed to ensure residents continue to have access to the high-quality long-term services they need as they age.

Adding to these challenges, Pennsylvania nursing homes are the target out of out-of-state predatory lawyers who are filing frivolous lawsuits seeking settlement payouts, because of the state’s lax tort laws related to long-term care. As a result, nursing homes spend in excess of $90 million annually in liability-related expenses — money that should be used to improve the quality of care and the quality of life for nursing home residents, but instead goes into the pockets of predatory out-of-state lawyers.

Despite these challenges, Pennsylvanian nursing homes continue to rank among the best in the nation for the quality of care they provide,” said Paul McGuire, PHCA Board Chairman and vice president of operations of Mid-Atlantic Health Care. “According to the latest federal 5-star rating system, a consumer tool, Pennsylvania nursing homes improved or stayed the same on 8 of the 11 quality measures and now rank better than the national average on 8 of those same 11 measures.”