------------------------------------------------------------------------------ NewsBank, inc. - The Commercial Appeal - 1998 - Article with Citation ------------------------------------------------------------------------------ Headline: PATIENTS HOPE MEDICAID WILL EXTEND TO HOME BASE \ ``I'D LIKE MY FREEDOM BACK.'' - MYRA STRAIGN Date: March 23, 1998 Section: News Page: A1 Edition: Final Length: 1474 words Author: Mary Powers The Commercial Appeal Index Terms: LEGISLATURE LEGISLATION TN HEALTH CARE COST FINANCE Text: Complications from a biopsy sent Myra Straign to the hospital and then a nursing home. A broken leg and crippling arthritis kept her there. Now the 46-year-old Memphis resident wants out. "I'd like my freedom back," says Straign. The problem is money. Straign says she cannot pay for support services she'd need in her home. Medicaid, which pays her Saint Francis nursing home bill, usually won't. In Nashville, the General Assembly is considering legislation designed to change that. The legislation would expand Medicaid funding for the homemaker, respite, day care and other services to postpone nursing home care for Straign and other aging or disabled Tennesseans. Getting the legislation passed tops the American Association of Retired Persons' state legislative wish list. It's been endorsed by disability advocates. Representatives from more than 22 seniors and disability groups, health providers and local governments turned out this month when a sponsor of one of the bills visited Memphis. The bills call for diverting half of any future Medicaid budget increase to pay for developing a state long-term care plan. For Medicaid-eligible Tennesseans, money also would be available to pay for such services as transportation, home-delivered meals and personal care. "We anticipate using some of the money to work with groups, like the Alzheimer's Association, currently providing these services who have a waiting list," said Rep. John Arriola (D-Nashville), the bill's House sponsor. Arriola said the legislative intent is to also make services available on a sliding fee scale to individuals whose incomes mean they're excluded from Medicaid. Nursing home administrators embrace expanding services, but not with money diverted from that industry. "There is no slack in the nursing home budget to pull money from," said Marvin Silver, former director and now a consultant to the 144-bed Memphis Jewish home. Health Commissioner Nancy Menke declined comment on the legislation, but said the state is interested in expanding such services. House Bill 2842 is scheduled for a vote Tuesday in the House Health and Human Services Committee. On Wednesday, the Senate General Welfare Committee is scheduled to consider the proposal, Senate Bill 2411. Arriola said the legislation is a response to a 1997 Tennessee comptroller's report warning that the state faces a long-term care crisis fueled by the predicted jump in older residents, many who will likely be poor. "Tennessee must develop a comprehensive and focused plan for the long-term care of its elderly," the report advised. It cited home and community-based services as a way to reduce Medicaid expenditures for nursing homes while providing needed care. However, the report warned that expanding community services could initially generate a demand for services at a short-term cost increase. Tennessee's current Medicaid budget is $672 million, most going to underwrite nursing home care for about 30,000 Tennesseans. Medicaid is separate from the state's TennCare health care program. Medicaid qualifications are linked to income and assets. An individual must earn less than $1,482 monthly. More than 70 percent of Tennessee nursing home residents qualify for Medicaid, which is funded with state and federal dollars. Pilot projects under way in Shelby, Davidson, Knox and Hamilton counties provide home services to certain Medicaid-eligible residents who would otherwise need nursing home care. Those programs serve up to 550 annually with budgets of about $5.5 million. Tennessee is also seeking federal approval to replicate a program designed to help frail elderly residents remain at home. Implemented or under consideration in 31 states, the program combines Medicare and Medicaid funding with a managed care approach. But critics note that Tennessee ranks 49th among states in Medicaid spending for home and community based services. That is one reason Janie Twaddle, 70, of Cordova joined an AARP-sponsored lobby effort March 18. About 60 individuals rode buses to Nashville to urge expanded services. Chemotherapy left Twaddle with nerve damage and foot pain that makes it difficult to walk or stand for long periods. She's still active and living independently thanks to her motorized scooter and a lift van. "It's hard for me to maintain my lifestyle, but I don't want to go live in a nursing home," said Twaddle, who said she wants to ensure services are available to keep her at home. "I don't want my children to give up their work to look after me. I want to be self-sustaining." Straign has turned to the Memphis Center for Independent Living for help arranging the housekeeping, transportation and other services she'll need to live alone. "There's no reason she should be in a nursing home. We are determined to get her out," said Deborah Cunningham, center executive director. "A good portion of our consumers would benefit" from increased home and community services, she said. The center serves 500 to 800 annually. Cunningham dismisses Menke's call for additional pilot programs. "That's nonsense. Everyone's too chicken to deal with the nursing home lobby." Between 1994 and 1996, the nursing home industry's political action committee has donated $30,500 to Gov. Don Sundquist's campaigns. In 1996 and 1997, it donated $48,100 to 42 state legislators, including Arriola. No one knows how many nursing home residents there are who, with help, could live outside an institution. A few, like LaTonya Reeves, 33, leave the state rather than move into a nursing home. In 1991, Reeves, who has battled blindness and cerebral palsy since birth, moved from Memphis to Denver. Today she lives in her own apartment and works with help from Colorado Medicaid. The program pays for help with personal care like dressing and meal preparation. To qualify for Medicaid, residents must need help with at least three activities of daily living, Menke said. Nursing home administrators said residents today are generally sicker than a decade earlier. "With a few exceptions, these people cannot be cared for at home," Silver said. The 1997 comptroller's report cited Wisconsin, Oregon and Washington as success stories. Between 1979 and 1995, Oregon shaved long-term care costs by $400 million. Between 1982 and 1992, total nursing home beds in those states declined as home and community services expanded, the report noted. Those states, however, have controlled program growth, sometimes limiting access to services. Control came via case management, financial or need standards or by limiting hours of services or the dollar benefits per beneficiary. In Tennessee, Arriola said the program budget would dictate program size. The governor's proposed 1998-99 budget includes a 5.5 percent Medicaid increase. Under the proposed funding formula, that would translate into about $18 million for planning plus home and community services. Laura Bustetter Burke said that's $18 million Tennessee nursing homes need. Burke is a spokesman for the Tennessee Health Care Association, which represents 326 public, nonprofit and for-profit nursing homes statewide. Medicaid currently pays nursing homes about 65 percent of the average cost. "Our costs are still going up. This year's (Medicaid) budget is $19 million short," she said. In Memphis, diverting those funds could translate into staff cuts at King's Daughters & Sons Home, said Ron Arrison, executive director at the 108-bed nursing home. "We would have to cut back on hours in the patient-care areas. It might mean some residents don't get up every day," he said. All but two residents receive Medicaid support. Arrison and others urged legislators to find alternative funding for community services. They noted that the nursing home industry pays a tax of $2,600 per bed, money the state then uses to pull in additional federal matching dollars. Arriola argued that unlike other funding mechanisms, Medicaid is stable and linked to long-term care. He said he's seen no evidence nursing homes would be forced to cut services. "I think it's a matter of how much we would cut into their profits." \ To reach reporter Mary Powers, call 529-2383 or E-mail powers@gomemphis.com Caption: photo (2) Copyright 1998 The Commercial Appeal, Memphis, TN Accession Number: 9803230014 ------------------------------------------------------------------------------