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| State Senator Conrad Appel |
In the most recent battle to change the way Louisiana cares for its
elderly, nursing home owners were pitted against advocacy groups like
the AARP, asking the state to increase opportunities for senior citizens
to receive care in their own homes.
On Tuesday, the nursing homes won.
With
a 6-2 vote, the Senate Health and Welfare committee rejected
legislation aimed at giving more people access to home-health services,
in lieu of being sent to a nursing home to live.
“Today,
many members chose to ignore the tens of thousands of older adults in
their districts who want to live at home, while offering no alternative
or plan to help them,” said AARP of Louisiana lobbyist Andrew Muhl. “It
was disappointing, but we always knew this would be an uphill fight.“
The
Louisiana Nursing Home Association, representing 250 nursing homes in
the state, spoke against the measure, saying it would result in a
reduction in the quality of care.
The measure's sponsor, Sen. Conrad Appel, R-Metairie,
called Senate Bill 357 one of the most important pieces of legislation
lawmakers would deal with this session because it addresses the needs of
Louisiana's aging population and attempts to mitigate the skyrocketing
Medicaid costs required to care for their needs.
The elderly and
disabled Medicaid population makes up the majority of the state’s
Medicaid costs, which in large part is paid out to nursing homes.
SB357
attempted to move the Medicaid population in nursing homes under a
managed care model, which means the state hires private insurance
companies to make decisions about whether people should be cared for in
nursing homes or at their own home with supports and staffing. Home- and
community-based care is both less expensive and overwhelmingly
preferred by elderly people, AARP surveys claim.
The home-based
providers equip elderly or disabled people with medical support in their
own home. They also provide staff who help clean, cook, dress and run
errands for those in need of daily assistance. There’s 28,000 people on a
waiting list for these home-based services.
"What this does is
give people a critical life choice that has been denied to them in the
past," Appel said. "Either stay at home or go to a nursing home."
Louisiana’s
nursing homes are among the worst in the nation, according to national
rankings. Louisiana also spends less on home- and community-based
services than most other states. At the same time, nursing homes have
unique financial protections that ensure regular rate increases, while
other Medicaid providers have been cut year after year.
Several
senators, including committee Chairman Sen. Fred Mills — who owns an
interest in a Breaux Bridge nursing home — raised concerns that managed
care was too risky and unreliable a method for the state to take on for
its seniors, despite the fact that the vast majority of Louisiana's
Medicaid population is already under managed care.
Mills raised concerns that managed care would result in an increase in medical claims being denied by insurance companies.
Appel dismissed the concerns about managed care as political misdirection.
“We
have a huge managed care system in place in Louisiana for 1.3 million
people. Those are just talking points,” Appel said. “We have ample
evidence of the success of the managed care model in Louisiana.”
Proponents
of the bill said it would be at a minimum revenue neutral but most
likely generate savings for the state over the next few years, in large
part because the state charges managed care companies a 5.5 percent tax
that could generate about $100 million a year.
State Sen. Jay Luneau, D-Alexandria, was incredulous about the claim.
He
said if the goal is to give home- and community-based services to
thousands of people on the waiting list, then the state would have to
incur additional costs to serve a new population.
He said he'd prefer to improve access to home- and community-based services with more direct funding.
Luneau
also said he was concerned about diminishing care for the elderly. He
noted that people in nursing homes are within walking distance of people
who can assist them 24 hours a day. But with home-health providers,
they would only receive help a few hours a day.
Hugh Eley, a
retired 30-year administrator for Louisiana Department of Health, told
Luneau that many people in nursing homes and who are on waiting lists
for services can get by with a few hours of help per day. Those who
can’t, would still be allowed to go to nursing homes.
The Senate hearing was packed with nursing home
leaders, including several former lawmakers who have ties to the
industry or were major beneficiaries of nursing home campaign donations,
like former Speaker of the House Jim Tucker, former state Rep. Sherri
Buffington — who often carried legislation on behalf of nursing homes —
and former state Sen. Joe McPherson, who previously chaired the Senate
Health and Welfare Committee.
Rep. Bob Hensgens, R-Abbeville, who
is a nursing home administrator, also sat in on the hearing, watching
from the back of the room.
“This is emotional to me. It’s
disturbing to me,” McPherson told the committee. “I don’t want to have
to deal with insurance companies. There’s definitely a need for more
home- and community-based services, but this is not the vehicle.”
On
Wednesday, the House Health and Welfare Committee is scheduled to take
up a similar bill sponsored by Prairieville Rep. Tony Bacala. Bacala
said he was unsure if he’d pursue the bill because even if he got it
passed in the House, it would likely die the same death of Appel’s bill
once it made it to the Senate.
That committee will hear at least
two other bills opposed by nursing homes — one that would change the way
nursing homes are paid by the state and another that would allow
surveillance devices in rooms to monitor care.
Appel said he was disappointed by the failure of his bill, but he thinks his peers are delaying an inevitability.
“I
don’t think there’s any possibility this won’t go into effect in the
next couple years in some form,” he said. “The number of people becoming
eligible for these types of services are growing astronomically, and
the model of jamming people into an institution is just going to get
more and more expensive. We’re not going to have a choice.”
Those
voting in favor of Appel's bill were Sen. Dan Claitor, R-Baton Rouge,
and Sen. Ed Price, D-Gonzales. Voting against SB357 were Sens. Gerald
Boudreaux, D-Lafayette; Regina Barrow, D-Baton Rouge; Norby Chabert,
R-Houma; Yvonne Colomb, D-Baton Rouge; Dale Erdey, R-Livingston; and
Luneau.
Full Article & Source:
Bill that gives elderly 'a critical choice' to live at home or in a nursing home rejected by Senate committee