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What A Scandal - On So Many Levels! #208 (5/07) We try, truly, not to rant and rage or be too cynical or too offensive, at least not too often. However, the Wall Street Journal article on 5/7/07 "Battle on Home Front," just pointed out too many outrageous issues at the same time. article: WSJ.com - Battle on Home Front . All quotes below are from the article.]
A little background: Laguna Honda is a public nursing home in San Francisco which has 1,067 beds owned by the City. It is a decrepit place with wards up to 28 beds. As a result of a recent lawsuit, all residents were assessed. Surprise, surprise. 70% of the residents could reside in the community with appropriate services. The City's response? Build a new, bigger institution with up to 1,200 beds.
The buttons that pushed me over include:
1. "Prominent politicians such as Sen Dianne Feinstein and House Speaker Nancy Pelosi are on board for the new buildings, despite the opposition of the AARP and local groups for the disabled. Both have receive near the maximum campaign contributions from the SEIU International Union] since ... 1989. Representatives of Sen. Feinstein and Re. Pelosi said that contributions were irrelevant to their support and the new facility's medical services are needed."
Sure! Anyone want to buy a bridge for one dollar. Do they think we're really that dumb or naive? Will they give back the contributions they received since 1989, so then we might believe them? Do they know that 70% of Laguna Honda residents can reside in the community with appropriate community services, so that a new facility is NOT needed for them?
SEIU - you've told us you wanted a positive relationship with the disability community? We want your members to be adequately paid and employed. We want your membership to grow. But what about the civil rights of persons with disabilities? We respect workers' rights; how about you reciprocating and respecting the ADA and the Olmstead decision?
2. Sen. Feinstein said "sure it would be nice if you reinvent the wheel."
"Reinvent" what? Doesn't she know about attendant and personal care services in the community? About MA's waiver services? Where is Ed when we need him in California to explain to her that he lived in the community. To explain to her thatfor each person with any condition or diagnosis in Laguna Honda, there are people throughout the country, and yes even in California, in the community with the same condition and diagnosis. Nothing needs to be invented, let alone reinvented.
3. "San Francisco Mayor Gavin Newsom, who has received virtually no SEIU money, voted against a bond issue for the new building, but says he found that position 'politically very damaging'." He says "he continues to face intense pressure to build and fund the full nursing home as planned."
If the Mayor, whose city owns the nursing home, does not want a new building, why doesn't he just say "no." Oh right, too politically damaging. But from whom? Doesn't he sound like the mayors in the 50s who said they really wanted to integrate racially their schools, but there was too much pressure. Aren't the civil rights of people with disabilities worth taking political pressure or worth fighting for?
Does the mayor know that under Title II of the ADA, his "public entity" must provide services "in the most integrated setting," i.e., the community. Is he ready to provide community services to the 70% of the current residents who could live in the community with appropriate services?
4. The federal MA funding agency, CMS, is a critical part of the effort to build a Laguna Honda. Because Laguna Honda has only 20 beds 1067] that are licensed as a hospital, this "almost doubles its Medicaid reimbursements for ALL of its patients to $338 a day."
Let's get this straight. If a nursing home has less than 2% of its total beds licensed as "hospital beds," then CMS reimburses all 100% of the beds as hospital beds. Hmm. Great, great scam! Yo CMS, is this the same for all nursing homes?
5. Added to the CMS's MA reimbursement, the city - Mayor Newsom - pays an additional $93 dollars a day per person, for "an average $431 per patient per day in total government reimbursement - compared to an average of about $171 that nursing homes in the area typically receive." Mr. Mayor, are you sure you do not receive any SEIU funds? Take a page from fellow-Democrat New York Governor Eliot Spitzer, who "labeled the SEIU" guardians of the status quo' as he waged a bruising battle earlier this year..., arguing that the health system is too centered on hospitals and nursing homes."
CMS - let us understand correctly, $171 a day for other nursing homes in the SF/California area and $431 for Laguna Honda.
6. Ok, $93 a day of San Francisco city funds for 1067 persons equals $99,231 a day or $36 million a year to Laguna Honda.
Does San Francisco provide $36 million a year for community-based services? If not, what about the ADA? Olmstead? "Most integrated setting?"
7. Folks, $431 a day for a year is $157,315. We understand that California is one of the lucky states that has been awarded a CMS Money Follows the Person grant. Just think what community services could be purchased with $157,315 a year.
We are correct, aren't we, that the total $157,315 a year will follow the person into the community?
8. $431 per patient a day, you say, is still too low; $157,315 a year is not enough. OK. "The new Laguna Honda nursing home would collect closer to $500 a day per patient, partly thanks to added payments by Medicaid and the city to defray costs related to the rebuilding."
We're too flabbergasted to ask CMS "how could you?" Are you at all embarrassed?
9. The real reason the Mayor, the State, SEIU, the elected officials, and presumably CMS support the building of a new Laguna Honda, ready with the trumpets, is that it will have a "large petting zoo, aviary, gardens, orchard, meadow, two therapeutic swimming pools."
That is true! We're not kidding. Just like a fancy condo or the Hilton. Will it be fenced off, too? Free parking for the residents or valet parking for the residents and guests. How about a three star restaurant and a Starbucks?
10. Yes, we're stuck on $157,315 a year. The "average Medicaid costs for home care may be almost a third LESS than for nursing homes -$34,400 versus $46,612 per year - even when factors for rent and food at home are counted in...." But that's the average nursing home costs for nursing homes other than Laguna Honda. For us, it's $34,400 versus $157,315! That makes Laguna Honda 3 times MORE expensive than living in the community.
11. "The Center for Medicare & Medicaid Services agrees home care generally is better for patients and more economical."
CMS - talk is cheap; stop the chatter. Tell California, the Mayor and Laguna Honda that for the 70% assessed persons in Laguna Honda who can be served in the community with appropriate community based services, they must be offered appropriate community based services.
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.
-- Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins are available online at http://www.stevegoldada.com
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