Elderly already taking a hit. Nursing home cuts by CMS taking a toll.

[madfloridian]

With all the talk about what the Super Committee has in mind for us seniors, there's not a lot of mention made that the cuts are already starting. And they are painful indeed.

From the Sacramento Bee:

The elderly are already taking a hit

While national politicians argue about cuts to Social Security and Medicare down the road, cash-strapped state governments are cutting vital services for elderly Americans today. Those suffering most are often those with the least.

In California, budget cuts approved earlier this year mean the closure of some 300 adult day health centers. These centers serve 37,000 medically fragile elderly and disabled people - folks suffering from Alzheimer's disease, stroke or other complications that make it impossible for them to function without assistance. The centers allow them to live a bearable life outside of a 24-hour institution. And they give the family members who care for them at home a desperately needed daytime respite.

While California's situation may be the worst, it's not unique. Washington state's COPES (Community Options Program Entry System), which helps the frail elderly live at home, has also faced severe cuts, and there's good reason to fear for similar efforts in other states.

And the same thing is happening in Florida. People often don't find out until a center is closed. There's just not a lot of publicity.

Skilled nursing facilities are taking a big hit.

Skilled nursing facilities warn of zero profits if more cuts are made

WASHINGTON – Continuing their crusade to make the congressional super committee aware of the repercussions of how cuts to Medicare and Medicaid will impact the skilled nursing facility industry, SNF advocates have released an analysis by Avalere Health that finds if more cuts are made, the industry’s operating margin will be zilch.

Avalere, a healthcare business strategy and public policy advisory company, did the analysis at the request of the Alliance for Quality Nursing Home Care (AQNHC), a long-term care member organization. Avalere’s analysis offers different scenarios, all with negative consequences for the operating margins of SNFs:

• Cuts to Medicare and Medicaid on top of the payment reduction and other changes laid out in a final rule by the Centers for Medicare & Medicaid will result in a SNF industry-wide overall (all payers) reduction in operating margin from 3.8 percent to zero in FY 2012; from 4.4 percent to 0.4 percent in 2014.

..."This is the second analysis of the impact of cuts on SNFs that Avalere has released this month. The first found that CMS’ final rule cuts of 11.1 percent would mean payments to SNFs over the next 10 years would be reduced by $79 billion.

Here is more about the cuts to services offered by nursing homes that will occur under such cuts.

Budget Cuts: To Affect Nursing Home Costs (And Services)?

"If you have a loved one in a nursing home now or in the near future, then be ready to pay more and, perhaps, receive fewer services due to tightening Medicare and Medicaid budgets. In fact, you may notice an uptick in your "house bill" as early as this fall."

The last few months have been a wild ride on multiple financial levels. This include wild financial consequences at the micro level (e.g., putting gas in your tank and buying milk) and at the macro level (e.g., future funding of Social Security, Medicare, Medicaid and the very real "debt crisis"). While many more challenges lie ahead in terms of budget cuts, some cuts already have been made... albeit under the radar screen.

Several of the budget cuts you should know about actually go into effect this fall, as reported in a recent SmartMoney article. According to SmartMoney, nursing home residents could face higher costs or reduced care once these cuts kick in. Yikes!

On July 29, The Centers for Medicare and Medicaid Services (CMS) decided and announced that they would be compensating for last year's $4 billion shortfall by cutting reimbursement rates to nursing homes by 11.1%. In real terms, the shortfall will reduce government reimbursements to nursing homes. In 2010, nursing homes across the board increased charges on residents by an average of 5%.

The bad news: These reduced government reimbursements likely will trigger even higher nursing home costs for residents beginning this fall. Alternatively, it might trigger a reduction in services to nursing home residents. Either way, the forecast is not pleasant.

Yes, "under the radar screen". And probably more to come when the Super Committee gets through putting everything on the table to get the $1.5 trillion in cuts...maybe more if the president gets his way. He is asking for more than that.

So they are already doing it to the elderly, cutting benefits. To the young folks who think oh goody they are saving money for me in my future....I say good luck on taking up the slack provided by Social Security, Medicare, and Medicaid. I say your lives are about to change, and you will be taking on the responsibilities that your parents and grandparents were able to do for themselves with the money they contributed through their working years.

And shame on Democrats who know what is happening and are refusing to buck the administration on this.

[emilyg]

1. K/r

[DollyM]

2. nursing homes are already cutting back . . .

I was 20 hours a week as an activity assistant and got cut to 10 hours a week since the state was 6 months behind in making their Medicaid payments to the home. And that was over a year ago. I volunteered the other 10 hours as long as I was financially able and had to look for something else. You would be surprised at how many people put in time they are not paid for at the nursing home simply because there isn't enough money and staff to go around. You would think we could do better for our elders than this. They are the people that built this country and it seems like it is my generation that is destroying everything they built.

[eShirl]

4. thank you for all you do for our elders

:grouphug:

[madfloridian]

19. Thank you for posting that. Yes, you would think we could do better.

I think we have let the extremists in the right wing set the messaging for so long that now we don't know how to stop it.

[postatomic]

24. Kudos

A huge THANK YOU.

I was one of the unpaid volunteers. I quit because I made too many very good friends and I couldn't deal with the Grim Reaper showing up on a regular basis.

I think there was 3 or 4 paid full timers that were let go while I was there.

If I can get over my own personal issue regarding 'death' I'd love to help out again at a few places. I try to tell myself that if I can make someone smile or restore a little purpose in their life, even if it is for a short time, then that's a good thing.

There will be no consideration in Congress for this in whatever the fuck they plan on doing when the Council of the Clueless meets to decide the future of this country. There isn't any elderly lobbying group to wine and dine them.

[DollyM]

36. I began my career working for Hospice . . .

That isn't for everyone either, I saw nurses quit after one day when the young ones died. I think it made a profound impression on me and made me face my own mortality. When you can come to that point, then it is "easier" to deal with the cycle of life. Working with hospice made me more thankful for my own loved ones and the uncertainties of life. Working at the nursing home was just an extenstion of that. For me, it was something that saved my life. My son was killed in a car accident and I spent about 4 months just curled up on my bed, not caring if I lived or died. Then the local nursing home, where I had volunteered over the years off an on, called and said they had an opening in Activities and asked if I wanted the job. I jumped at the chance. That opportunity took the giant hole in my heart after my son's death and filled it with many people to love. So that is how I see it, just another person who is in need of love and who have love to give as well as receive.

[DollyM]

37. There is a TEA party rally here in a couple of weeks . . .

They have four "speakers" who will be addressing such things as healthcare, amazingly enough (sarcasm here), two of the speakers are MD's. I am sure the prospect of cutting into their million dollar home and sports car budget, has them shaking in their boots. I don't know how people can be so dumb that they can't see this for what it is, protecting the greed of people who only want to protect their bottom line.

[madfloridian]

38. Amazing and courageous story.

Thanks for sharing.

[JDPriestly]

3. People will die because of these cuts.

Just wait. This will become very apparent.

[cutlassmama]

5. they don't care as long as they are making profits, it's the only thing

that matters to sociopaths.

[durablend]

6. Just some minor "streamlining"

Only cutting out some of the "waste" in the system...nothing to see here!

:sarcasm:

[XanaDUer]

7. This is what I meant yesterday that, literally, lives depend

on how Obama approaches the myriad problems we're facing.

[madfloridian]

10. Yes, lives depend on what Obama does as president regarding seniors.

And yet many seem to think whatever he does in this area is fine. It's scary to me.

[DollyM]

21. I think this shows great disrespect to seniors . . .

I wonder, what if Michelle's mom ends up in a nursing home that has taken these cuts. I would like to see what he thinks when there isn't enough staff left to take "mom" to the bathroom when she needs it, or the activity program has been cut to nothing but cards twice a week and Mom is sitting around starting into space. Obama needs to SEE what is really going on with the nursing homes system and how cuts are going to just further undermine the care available.

[truedelphi]

27. If a group of people can overlook what he said he would do in

Terms of NAFTA (That is, end it and start seeing that we manufacture things here) and what he said in terms of ending the war in Iraq and most recently "drawing down troops in Afghanistan," and then they can overlook his policy of letting the Bush Crime Family members including Cheney and Rumsfeld go scot free, and if people can overlook how complicit Obama was from Day One with the Uber Elite of the Banking crowd, why in the world would that same group of people care what Obama does on any other issue?

The only way that anyone can support these things is if they are part of his inner circle, or being paid to help him "massage' his "message."

Or if they are very rich, or young enough, and holding down a good job, while life's burdens still seem several decades off.

[Odin2005]

8. And don't forget all the disabled folks that need 24hr care.

Here in Minnesota budget cuts mean that group homes are becoming increasingly short on staff and mileage allowances.

[TBF]

16. Disabled and also elderly -

some folks can live on their own for awhile; but when the elderly have strokes and the like they are just as vulnerable as the disabled. Both need skilled 24-hr care. Sadly our Congress does not care about that at all - I guess they figure folks will have to rely on private charities, churches, etc...

[classof56]

9. This is flat-out shameful and completely unnecessary.

Lately, I've been asking myself over and over how the republicons in charge can be so cruel and uncaring. Seriously--how?? Somewhere they checked their hearts and souls at the door, sold out to money and sold the rest of us down the river. I know--that's not news, and I don't really expect answers. I hold out hope, not sure why anymore, because if I don't, I see absolutely no future. The "trickle down" effect of this CMS action is mindboggling. Not only are those most in need tossed to the curb, but those who have devoted their lives to helping them are tossed away as well. Jobless numbers will soar. And as you point out, no money will be saved for taxpayers because all the benefits go to the rich and powerful who care nothing about us. Nothing.

Cruel and uncaring...cruel and uncaring...that's my mantra now. I'm in my 70s and have never felt so hopeless and helpless. Shame on everyone, dems and repukes, for letting this happen.

Tired Old Cynic

[madfloridian]

11. For the last 3 years Democrats have been in the majority.

So they share the blame for letting the GOP control the message.

Yes, I think we have become a cruel and uncaring country. I feel pretty cynical also.

[woo me with science]

18. DEMOCRATS ARE SUPPORTING THIS SHIT, TOO, INCLUDING OUR PRESIDENT.

These are not fucking games that the Third Way is playing. People will die.

[classof56]

22. Well, I did say "shame on dems"

Guess that would include the President. I understand these are not games, f'ing or otherwise, and yes, people will die. The one thing that's crystal clear to me by now is the republicons in particular simply Do. Not. Care. Not quite sure what to do with that, except do what I'm doing, let my voice be heard and VOTE!

Blessings.

[eilen]

42. They are dying

cuts in budget means cuts in food services. People with congestive heart failure are supposed to eat a low sodium diet. If they are in stage 2 or 3 of advanced cardiomyopathy and are being fed hotdogs-- which they are because hotdogs are cheap, they end up in the ED within 48 hours with respiratory distress, pleural effusions which can easily turn into pneumonia.

I've talked to many patients and they tell me that everyone is fed the same thing at the rehab/skilled nursing facilities. This really sucks because the government is washing their hands of the responsiblity for the damage being done.

We discharge a person with CHF to rehab at a skilled nursing facility, within the week they are back with symptoms d/t non-adherence to low sodium diet -- plus they are not getting weighed every day at the same time-- with an average stay of 5.2 days. In January the hospitals will no longer be paid for a readmission for CHF within 30 days of discharge. The problem can be a UTI but if they have CHF, we will still be shorted-- I think the only exception might be trauma. The hospital will then end up cutting staff to compensate for the lack of revenue.

[TBF]

A very important post -

we've dealt with rehab centers in FL this past year (and long-term care policies). What a nightmare. What we have right now is two elderly parents (mid 80s) with health issues still living in their home. They want to be there, so we've hired nurses to come several times a week to check on them and drive them to their doctor's visits. Sadly that is probably a better alternative than putting them into a care center. We're still worried about them, but they can be together and along with the nurses the neighbors do stop by frequently. And we are lucky - we have some resources to pay for these things (at least for now - how long that lasts will depend upon their health and needs). Lord knows what families without resources are going to do ...

[madfloridian]

13. "Lord knows what families without resources are going to do"

That's such an important statement. I think there seems to be no party especially worrying about those without resources right now. They seem to be too busy trying to see who can make the most and deepest cuts to everything. :shrug:

[RamboLiberal]

20. as someone without a family

Heading into senior years and facing a possible disability that could rob me of my mobility and use strength of my hands the prospect of personal care homes & nursing homes & how quickly they could deplete my retirement savings scares me. Then we have these f'ing repukes & the dems going along with cuts.

Those of you with good family taking care of elders count your blessings.

Amazes me how the medical & govt world seems to assume everyone has a caregiver. I'm sure there are many like me who don't.



.

[NCarolinawoman]

12. ......and the wars drag on....

:banghead:

Maybe China will give us some foreign aid.:sarcasm:

[Iwillnevergiveup]

46. That would be nice

but we could also take some pointers from the Chinese on revering and caring for our elderly.

[sarcasmo]

14. When my wife became ill three years ago I told her our house was her nursing home.

I will never! let a loved one be put in a home. I am lucky to have the financial resources to be her full time caregiver.

[madfloridian]

15. Read the comments from FL nurses after this article about FL cuts.

http://orlando.injuryboard.com/nursing-home-and-elder-abuse/future-of-florida-nursing-homes-looks-bleak-due-to-state-and-federal-budget-cuts.aspx?googleid=293378

From the comments:

"Every Floridian should be aware that in 2001 1199SEIU Certified Nursing Assistants(CNAs) lobbied for and got bipartisan support to pass the 2.9 law, requiring an average of 2.9 hours of direct CNA care and 1 hour of RN/LPN care per resident per day. Underfunded until 2008, the law included tort reform and transformed care in nursing homes throughout Florida. Before the law, the average resident received about 1.6 hours of care per day. In 2010 the law was rolled back to 2.6 hours by the Florida Legislature and in the last session, in an 11th hour, back-room deal, Republican majority legislators permanently decreased the hours of care to 2.5 per day. Governor Scott signed it in to law.

So the Florida State Budget was literally balanced by depriving nursing home residents of 24 minutes of care per day- a lot when you consider how long it takes you to shower, brush your teeth and eat breakfast. What if you could not do those things without help and they just cut the help? What if you could not get to the bathroom without help and they cut the help?

Why should all of us care? As stated in the article- this means layoffs and less money spent in the Florida economy. More people looking for jobs and losing their healthcare insurance.

Cutting Medicaid is a lose-lose as the Medicaid dollars the legislators appropriate draw down matching dollars from the Federal Government. The Florida economy does not need more money sent back to the Feds that could have been spent here."

[L0oniX]

17. But this is Gods country.

[KamaAina]

23. People with disabilities taking a hit, too.

One-quarter of nursing home residents are people under age 65 with significant disabilities.

Then again, they don't really want to live in nursing homes, anyway, so if CMS was really serious about saving money, it would put more resources behind the Money Follows the Person program that lets people get care in their own homes, often at a substantial savings. Oh yes, the Supreme Court's 1999 decision in Olmstead v. L.C. establishes their civil right to live where they wish.

[Skidmore]

25. Might as well take the elderly out in the wilderness and leave them

to die. This is exactly what they are doing. Culling the herd.

[madrchsod]

26. we`ll see more people committing suicide rather than lose their dignity

[indepat]

28. Fuck 'em, let 'em die seems America's answer to the phony debt ceiling crisis and out-of-control

debt occasioned by perpetual wars and allowing the uber-wealthy and large corporations to continue to slop/suck at the public welfare teat on the backs of the old, frail, and poor. Disgraceful, depraved, and devoid of humanity, so what else is new: 'cause we live in a RW-dominated society and that's the RW solution. :patriot:

[Tuesday Afternoon]

29. k&r

[MissDeeds]

30. Our country is losing its conscience

and its soul. I never thought I'd see 'this' United States in my lifetime.

:cry:

K&R

[nineteen50]

31. Shared sacrifice my...

The number and dollar values of corporate, banking and small
business tax breaks over the last 4 years should be considered
in the shared sacrifices debt reduction talks. Also consider
government pay freezes, pension plan reduction, increased
medical costs and budget cuts and layoffs of public employees.
We also need to allow the federal government negotiate drug
costs based on volume no more retail price for Medicare drugs.
Also consider the profit increases of international
corporations over the last four years; Above all remember it
was not the poor, elderly and infirmed that created this
economic problem. The debt transfer over the last 5 years from
the private financial sector to the public sector created this
problem, Take back the bonuses.
    Reduce all tax deductions by 5% for personal, business and
corporations. All allowances, depreciation, subsidies etc.
across the board so it is a shared sacrifice.

[Marnie]

32. I been tell' you guys this since Bush, early in his first term, wanted

to put more arsenic in our water.

The way the government is going to solve the Medicare/aide SS problem is to kill off the poor and middle class.

The average life span of lower and middle class Americans is decreasing, only the wealthy are getting longer lived.

Kill off a couple of M special needs kids, crips, brain damaged vets, asthmatics and aging Baby Boomers, before they can get all their investment back, and problem solved.

SS back into the black column and then they can privatize and scoop up the profit.

Hell. Look at the Republicans like Alies and the Kochs. You don't think they are capable of doing that?

[WinkyDink]

35. I think billionaires, almost by definition, are capable of any deparvity.

[Hubert Flottz]

33. Well, look at the bright side...

Wealthy people can keep right on paying less taxes, than the guys cutting their grass pay.

[WinkyDink]

34. Gotta prepare for ridding the world of Boomers!

[Starry Messenger]

39. k&r

[swilton]

40. K&R

[defendandprotect]

41. K/R -- Bastards -- !!

[jwirr]

43. These cuts are not only going to hurt the elderly and their families

but the taxpayer is going to get screwed as well. When they cut programs like these that support community based living many families have no other choice but to put their elderly member into a much more costly nursing home. In such a facility the tax payer is paying for skilled care 24/7 instead of the family providing the care at home.

[begin_within]

44. It is so cruel.

[tooeyeten]

45. it doesn't effect

the families of CEO's on Wall Street, or even candidates families like Romney or Bachmann. Now the tea party families, first in line, but they'll continue to support the GOP anyway.

[defendandprotect]

47. kick

[girl_interrupted]

48. "A nation's greatness is measured by how it treats its weakest members." ~ Mahatma Ghandi

"Our society must make it right and possible for old people not to fear the young or be deserted by them, for the test of a civilization is the way that it cares for its helpless members.~Pearl S. Buck

I think these quotes say it best. I'm not sure what is happening in our society or our governmemt today, but it's scary.

[mother earth]

49. Just in time for the aging baby boomers...GOP death squads,

and Blue Dog enablers. This is why we need true progressive values represented & fought for. You judge a society by how it deals with the weakest and those who cannot speak, nor fight for themselves. Progessive values are not godless, this is godless.

[blkmusclmachine]

50. Oppose or support...

"you're either with us, or against us" applies to DC DEMs, too.