Doing more with less is dangerous practice

    First, it appears that Rhode Island finally ranks No. 1 in something. According to the 2010 U.S. Census, our state has the highest percentage of citizens over the age of 85.  Why? No one knows. Apparently, we live longer and stay here for our really golden years. Whatever the reason, it appears that more of our citizens choose to grow old in Rhode Island than in any other state.
    Second, a study recently released by the Center for Gerontology and Health Care Research at Brown University shows that Rhode Island’s nursing home population is more frail and dependent than ever before. One fact ties into the other. It’s easy to understand that as we age, the more intensive our health care needs become and as our 85-plus population continues to grow, so too will the need for long-term care services.
    What’s interesting is that it’s long been touted that Rhode Island’s long-term care Medi-caid costs exceed that of other states.
    Policy-makers have argued that those costs need to be brought into line with counterparts throughout the country. Unfortunately, the impact of Rhode Island’s large percentage of elderly over the age of 85 – those who use nursing home care the most – is commonly overlooked.
    The results of the 2010 census and the Brown study come at a time when state officials are redesigning the payment system for nursing homes to an acuity-based system.  Therefore, never has it been more important to have a clear understanding of two trends:  the number of Rhode Island’s elderly needing the intensive services provided in nursing homes is disproportionately large compared to other states; and the role of the skilled nursing facilities has changed over the years. Today’s facilities are not convalescent homes; they have morphed into centers providing intensive short-term rehabilitation and recuperation following a hospital stay or long-term care for Rhode Islanders with chronic and medically complex conditions.
    While assisted living and home care services are touted as less costly alternatives to nursing home care, those valuable services are designed for different populations. Only nursing homes deliver the level of care needed by those requiring 24-hour nursing services. Robbing Peter to pay Paul or shifting funds from nursing home care to community-based care – is not the answer. The entire long-term care system needs to grow to reflect Rhode Island’s demographics.
    Despite the legislature’s original intent to align payments to skilled nursing providers to the acuity of those they care for, there seems to be an inclination on the part of the administration to develop a payment system that doesn’t account for the additional resources needed to care for the oldest segment of our senior population. People in Rhode Island’s nursing homes require more staffing, more therapies, more medication and more resources than ever before, yet the funding for those services has been cut by millions of dollars in recent years.
    Eventually, the practice of being told to deliver more with less has to end. Unless policy-makers begin to realize the needs of Rhode Island’s seniors, we will continue to sell short the needs of our oldest generation. Rhode Island is one of the top states in terms of quality care in nursing homes, according to nationally reported quality indicators. On Jan. 1, when the new payment system is scheduled to go into effect, access and quality to nursing home services could change drastically. Seniors across the state should be aware of that.
    Last year, our legislators asked for the development of a payment system based on meeting the growing needs of nursing home residents. It’s up to the Department of Human Services to deliver that system. In doing so, the administration should be mindful that the care of our most frail and dependent population should never be compromised to balance the bottom line.

    Joan M. Woods is chair of the Rhode Island Health Care Association (RIHCA), a nonprofit association comprised of about two-thirds of the state’s skilled nursing and rehabilitation facilities. She is also executive administrator of the Genesis HealthCare Grand Islander Center in Middletown. She can be reached at (401) 849-7100 or joan.woods@genesishcc.com.