Tough times for long-term care

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Could things get any gloomier? I hate to be a pessimist, but when you look at the landscape—from Medicare and Medicaid cuts to the shortcomings of the Five-Star Quality Rating System—the hits to nursing homes just keep on coming.

Bruce Yarwood, president and CEO of the American Health Care Association, said as much at the AHCA conference Monday. He compared the string of challenges confronting the field to a tsunami. Not a squall or tidal wave, mind you, but a tsunami. (He talks about his concerns in a video interview with McKnight's. You can see it on the right-hand side of the home page.)

Contributing to this “perfect storm” is healthcare reform, which, thus far, does not look to be very favorable to nursing homes. Even in a best-case scenario, the legislation likely will call for a reduction in the market basket, or cost-of-living increase, for facilities, experts believe.

Meanwhile, nursing homes are still trying to get a handle on cuts of approximately $16 billion to Medicare over 10 years from a 3.3% reduction in Medicare rates. And a major disappointment to facilities has been the Medicaid funding from the stimulus package. The states are channeling it—not to the intended recipients, which include nursing homes—but to help their bloated budget deficits.

And don't get Yarwood started on the Five-Star Quality Rating System that took effect in December. Not mincing words at the Opening General Session, he said, “This program sucks.”

That may say it all.

But of course, to take another viewpoint, the storm will pass, as all storms do. And there are positive things to focus on, too. The CLASS Act, which would create a long-term care disability program, may yet make it into a final healthcare reform bill. And there other good healthcare reform provisions, such as an amendment to eliminate co-pays for drugs for dual eligible beneficiaries in assisted living facilities.

Looking ahead, beyond this chapter of healthcare reform, Yarwood predicts that long-term care reform will take place in three to five years, when the crisis in Medicaid reaches a breaking point. Wait a second. Are those dark clouds I see on the horizon?


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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