Legislative Column for May 2, 2019
Have you visited a family member or friend in a nursing home lately? What did you think of the facility? At many residential care centers, especially those in rural areas, we see worn carpet, shoddy furniture and signs of neglected maintenance. Perhaps we notice the staff using dated equipment. Maybe we hear reports of meager meal offerings or skimpy portions served to residents.
Why don’t they do something with this place? Fix it up. Spend some money.
Regrettably, our way of funding residential care facilities almost guarantees that these centers age no better than their residents. Nursing homes are typically funded by Medicaid, which pays for long-term care in the absence of private insurance and after Medicare benefits have been exhausted. Nationwide, more than 60 percent of nursing home residents rely on Medicaid, which is called MO HealthNet in Missouri.
Reimbursement rates for residential care have remained essentially unchanged since Medicaid’s inception. A nursing care facility is paid the same today as it was decades ago. Even if an existing care facility were to raze their old building and build a new center, they wouldn’t get one more dime per day from the government.
There is absolutely no financial incentive for the owners of a Medicaid-funded nursing home to invest in their facility. None. No matter what they do, they will be paid the same.
Senate Bill 11, and a similar bill offered in the House of Representatives, provides for the recalculation of Medicaid per diem reimbursement rates for intermediate care or skilled nursing facilities once improvements are made to the facility. To qualify, facilities must invest more than $2,000 for every bed they serve.
Currently, MO HealthNet pays nursing homes as little as $135 per day, or as much as $170, depending on when the facility qualified for the program. Older facilities are paid the least, and always will be, unless something changes. The consequence of this funding flaw is that older nursing homes continue to decline, while residents whose families can afford relocation move their loved ones to shiny new facilities.
I first became aware of this recipe for decay several years ago when I chaired the Senate Interim Committee on Long-Term Care Facilities. A bill introduced in a previous legislative session would have required a regular revision of Medicaid reimbursement rates. My legislation is more modest in that it requires facilities to make improvements before they qualify for increased funding. Frankly, some facilities won’t be able to afford the investment, but it’s a start. If reimbursement rates don’t keep pace with higher operating costs, nursing homes and assisted care facilities will continue to struggle. Others may close entirely. At least five facilities in Missouri have closed in recent years.
Providing an incentive for intermediate and skilled nursing care facilities to renovate and remodel will result in better care and more pleasant living conditions for residents. Rewarding renovations will also spur economic activity in the community through increased spending on materials and labor. Increased per diem rates would enable facilities to pay higher wages and hire more qualified workers. It takes a special person to work at these facilities. They are passionate about their residents and are dedicated to providing quality care. They deserve to earn a living wage, but that won’t happen if their employers are not adequately reimbursed.
Increased funding for nursing homes is especially important in rural areas, where the local nursing home is often one of the largest employers. Many rural counties have only a single facility. If these small town centers close, residents must move to facilities in distant towns, further separating families.
There are many reasons to revisit the funding rates for nursing homes, but the best reason is the residents themselves. We owe it to our parents, grandparents, siblings and disabled children to adequately fund their care. I watch the bottom line on government spending as closely as anyone, but I firmly believe this is a situation that needs to be addressed. I have a heart for these people, and want to see them receive the care they deserve.
My SB11 has been passed by the Senate and is now before the House of Representatives for its consideration. The parallel House Bill 600 is working its way through the Senate’s legislative process. Whether either bill becomes law remains to be seen. There isn’t much time left. The First Regular Session of the 100th General Assembly ends on May 17. If the legislation is not truly agreed to and passed by that date, we’ll have to try again next year.
As always, I appreciate it when groups from around Missouri and from our community back home come to visit me at the Capitol. If you would like to arrange a time to come and visit me in Jefferson City, or if you ever have any questions, please don’t hesitate to contact my Capitol office at (573) 751-1882.