The following column is the opinion and analysis of the writer.
Maybe you saw the recent news article about an auditors’ report on stalled investigations into claims of abuse and neglect at nursing homes supervised by the Arizona Department of Health Services.
It was a shocking and sadly predictable picture of what happens when skyrocketing demand for services collide with spiraling costs and inadequate funding. The result: A perfect storm of frail seniors living out their days warehoused in understaffed and unsanitary facilities, and reports of abuse and neglect that go uninvestigated for hundreds of days.
I won’t point fingers. Most nursing-home staffers are caring, hard-working professionals. And facility operators must deal with dangerously low reimbursement rates and relentless expenses. It’s a squeeze, and their residents are the ones caught in the middle.
Going into a nursing home is usually a last-ditch scenario. Aging in place, at home, is by far the top choice. I founded an in-home-care agency in Tucson and I see that choice being made every day.
But home care is not an option for many seniors. In most cases, unless you have long-term-care insurance, you’ll pay for services out-of-pocket. In Pima County alone, some 159,000 residents are age 60 or older. Many have no savings. When an accident or illness takes away their ability to care for themselves, the state Medicaid system (known as the Arizona Health Care Cost Containment System, or AHCCCS) can help, through its ALTCS (Arizona Long Term Care System) plan. Medicare does not pay for long-term nursing home placement.
To be sure, ALTCS is a safety net, but just barely. To qualify, your income as an individual can’t exceed $2,313 a month. You can own your home and a car, and $2,000 in other assets. No nest egg for you!
Qualifying for ALTCS is only the beginning. Waiting at the end of the process is an underfunded, understaffed, underregulated nursing home. Consider this: The ALTCS reimbursement rate for nursing homes is $166 per client per day. Out of that the facility must provide room, board and care. It must pay for office expenses and your medications, laundry services and disposable medical equipment. Most current facilities were built in the 1970s and ’80s, so maintenance is costly — or deferred.
Federal regulations require that caregivers be certified nursing assistants. The pay scale for CNAs is about $13 to $15 an hour, and they’re expected to care for up to 10 frail older adults. And every shift, they confront a carousel of dysfunction. Who fell out of bed? Whose meds are misplaced? Who’s anxious and acting out? No wonder the personnel entrance is a revolving door.
Cara Christ, director of the health department, says the auditors only looked at a handful of “non-representative samples” and that her department meets federal standards. But she also said she was assigning two more staffers to investigate complaints. To actually do the job right, Christ said, her department needs “an additional 44 staff and an additional $3.3 million appropriation and general fund allocation.” Well, let’s get her the money.
Of course, that only covers the cost of properly investigating complaints. The real problem is that pitiful $166 ALTCS reimbursement for nursing homes. If you’re as appalled as I am, let the governor’s office know. Tell Gov. Doug Ducey it’s way past time to increase reimbursements for nursing homes. Remind him that how we care for our most vulnerable citizens reflects on us all.
You’ll find a contact form at azgovernor.gov. Or you can call his office at (602) 542-4331. But please, do it today, because bedsores never sleep.
Judith B. Clinco, RN, BS, is founder and president of Catalina In-Home Services Inc. and sits on the board of the CareGiver Training Institute. Contact Judith at email@example.com.
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