Opinion: Letter to the Editor: Medicaid Reform Begins at Home

Opinion: Letter to the Editor: Medicaid Reform Begins at Home

I believe there is a simple reform that will improve care and begin saving Virginia Medicaid dollars this year. It is simple. Make home-based care more available to those in need. Medicaid has become our primary long-term care program in America, covering two-thirds of all residents in nursing homes. A small and neglected part of that budget is home health care services. Most consumers of long-term care services would prefer to receive care in their home or community rather than an institution. This is both humane and shrewd. Patients do better at home and home care costs much less than institutional care. However, Virginia’s home care system has been systematically under funded for several years. The Virginia Department for the Aging estimates that about 22,000 patients are eligible for home care but service providers are simply not available. So, taxpayers end up paying for expensive institutional care, and patients are forced out of their homes.

It’s a difficult job being a nurse’s aide. You are in someone’s house, basically acting as a servant--cooking, cleaning, bathing the patient. The patient is usually old and has multiple medical problems. You need to keep a positive attitude. In Virginia, you are paid from a reimbursement rate that is 59 percent below the national average. Quality of care depends on reimbursement and quality is suffering. I have patients who have changed home health aides once or twice a month. One aide had to bring her children to her patient’s home because she couldn’t afford daycare.

Patients that require medical technology, such as a ventilator, IV therapy, feeding tubes, oxygen therapy, catheter changes, or a bowel and bladder program need a registered nurse or a licensed practical nurse. However, the reimbursement rates for these services are barely above the average wage, with no margin for benefits, insurance, travel or administrative costs. A registered nurse or a licensed practical nurse can easily make more money in a nursing facility, where institution reimbursements are higher. As a result, access to skilled nursing care in the home is limited.

It would be far cheaper to expand home care than to continue this dysfunctional system. We miss opportunities to place people in home care. Most elderly adults don’t need skilled nursing, but they are too old and frail to get by on their own. They go into nursing homes because they don’t have access to good home care that can provide assistance. Patients who can stay home generally do better. They have fewer bedsores, fewer falls, less depression and less infectious disease. We only have to look at the demographics to see the future. The elderly population is increasing, along with associated health problems. Virginia legislator must be more cost effective with our limited finds and target hirer rates for homecare. It’s a win-win for seniors.

Sue Luster