RespiteMatch.com Health Blog

By CANDICE CHOI
Associated Press Writer
September 21, 2005, 12:06 PM EDT

ALBANY, N.Y. — The state Department of Health is asking nursing homes this month to seek certification that would allow them to provide less costly care for healthier residents in an effort to trim waste in Medicaid funding.

Currently, nursing homes in New York state are only certified to provide a single level of care that covers a broad range of medical services.

In January, the “rightsizing demonstration plan” legislation was signed to allow nursing homes to also provide assisted-living care at half the cost of full nursing home care, according to the Health Department.

Nursing homes would apply for certification by Oct. 14, then demonstrate to the Health Department they are able to provide the different levels of care.

The legislation also allows nursing homes to seek certification to convert beds to adult day health care programs and long-term home health care program slots.

William Van Slyke, spokesman for the Health Department, said many older people are inappropriately placed in nursing homes, though he couldn’t give an estimate on how high the number is.

Industry officials say at least 10 percent of nursing home residents don’t really need to be there, said Robert Ward, director of research at the Public Policy Institute in Albany, a research arm of the state Business Council.

The Health Department last year issued citations to two of the state’s 670 nursing homes for inappropriate placement of seniors. Two homes have been cited so far this year as well.

“We believe we do a very good job on overall surveillance of facilities and we cite deficiencies when we find them,” Van Slyke said. “That said, we will continue to look for new ways to keep pace with the evolution of long-term care.”

Older people are frequently referred to nursing homes for short-term rehabilitation, then end up becoming permanent residents because there is no plan to return them to the community, said Susan Dooha, executive director of the Center for Independence of the Disabled.

“We see (inappropriate placements) all the time. (The Health Department’s) supposed to be monitoring to ensure there’s a discharge plan in place, but that’s really not happening,” Dooha said.

The medical needs of senior citizens on Medicaid living in the community mirror those on Medicaid in nursing homes, but the cost of living in the community is much less, Dooha said.

In 2003, 18 percent of those living in nursing homes expressed a desire to return to the community, Dooha said.

Of the 112,000 residents in nursing homes in New York, 75 percent are on Medicaid.

The state’s Medicaid spending on long-term care in 2003 was $16.7 billion; $7.1 billion of that was on nursing home care, according to the Kaiser Family Foundation. Total Medicaid spending that same year was $40.6 billion.

An investigation by The New York Times earlier this year found the state’s Medicaid program misspent billions of dollars a year because of fraud and waste. The investigation found the state’s Medicaid program spends more than any other state, including California, where the Medicaid program covers 55 percent more people.

The incentive for nursing homes to provide lesser levels of care is that it could help fill empty beds, said Dick Herrick, president of the New York State Health Facilities Association.

Nursing home occupancy rates in the state fell to 93 percent in 2003 from 97 percent in 1995. The occupancy rate is back on an upward trend, Herrick said.

The legislation also lets nursing homes apply to temporarily decertify beds that are not being used, saving the nursing home money. The nursing homes could recertify the bed if occupancy rates climb in the future.