Mississippi: Barbour targets Medicaid as way to balance budget

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Gov. Hayley Barbour (R)
Gov. Hayley Barbour (R)
Gov. Haley Barbour (R) is looking to Medicaid to balance the state's troubled budget. Barbour's proposal includes a 4% reduction in Medicaid payments to nursing homes and an 8% cut to hospitals and other healthcare providers.

Local Medicaid officials say that the state's nursing home and hospital reimbursement rates are already higher than in other Southern states.

Alan Brown, an administrator with United Methodist Senior Services of Mississippi, says his organization factored in a 5% cut (or $1.5 million) in its annual budget in anticipation of possible trims.

“For us, it's a matter of capping the budget in other ways,” Brown said. “We wouldn't cut services to elders. In these hard economic times, I trust that the governor is looking at every option. With the economy being so tough, something has got to give.”

Mississippi has approximately 629,000 Medicaid recipients. The majority are under the age of 21.

MIDWEST
Hispanics' dementia stigma
ILLINOIS—Alzheimer's specialists in Chicago have launched a new effort to educate the city's Latino population about the disease, as it affects Latinos about seven years earlier than it does white Americans.

Experts say that low income levels, language barriers and access to medical care contribute to higher rates of diabetes and high-blood pressure in Latinos, making them more susceptible to Alzheimer's, according to the Chicago Tribune. This has caused a public health crisis, according to the Alzheimer's Association.

Researchers found that the Latino culture places a larger stigma on individuals who have the disease, which affects Latino communities in many places. Latinos from rural communities still believe that the disease's symptoms in the elderly are punishments for sins they committed when they were younger, according to news reports. Other Latinos consider dementia a mental illness and, thus, shameful.

Facility bans sex offenders
WISCONSIN—The board of a county-run nursing home in Elkhorn, WI, Lakeland Health Care Center, voted in November to bar registered sex offenders from being admitted to the facility, according to local news reports.
Administrators at the 119-resident home asked the nursing home board to support the ban in order to protect the safety of residents and rehabilitation patients. Although the facility has not had a problem in the past with registered sex offenders applying for admittance, operators said they hope the ban would prevent problems in the future.
The measure would allow the center to conduct criminal background checks on applicants because simple Internet registries of sex offenders sometimes miss offenders, administrators say. The county would pay the $10 background checks.

Reform appeal allowed
OHIO—An Ohio federal judge recently allowed a lawsuit challenging the insurance mandate of the federal healthcare reform law to proceed to trial.

The lawsuit charges that the Patient Protection and Affordable Care Act's individual mandate violates the Commerce Clause in the U.S. Constitution. Judge David Dowd Jr. of the U.S. District Court for the Northern District of Ohio permitted this claim but dismissed all the others in the suit.

The judge's decision follows a similar ruling in Florida. There, a healthcare reform suit filed by attorneys general in Florida and 19 other states also will proceed to trial. Republicans who have control of the U.S. House, have called for a repeal of the law.

Focusing on home care

OHIO—A state-appointed advisory committee recently released a report on the future of Ohio's long-term care costs. Ultimately, the report and committee members concluded that the state should focus on keeping individuals out of nursing homes and offer more home-care services.

The report found that Ohio's elderly and disabled comprise only 20% of Medicaid beneficiaries but account for 68% of its costs.

According to the report, Ohio spends $1,400 per patient for home-care services, compared to $4,321 per patient on nursing home services.

The state should strive, according to the report, to put half of Ohioans who are over 60 and in need of need long-term care, in nursing homes and half in their own homes. This should be possible within three years, report authors contend.

The next step in cutting long-term care costs in Ohio, as detailed in the report, is reducing the number of young nursing home residents, who represent the fastest growing segment in nursing homes. Currently, half of patients under 60 are in nursing homes and half are in home care. The report says the ratio should be 40% to 60%, with 40% of younger patients living in nursing homes and 60% at home.

Nominee has industry ties
IOWA—Gov.-elect Terry Branstad (R) disclosed the nomination of Rod Roberts to head Iowa's Department of Inspections, despite his having what critics say are conflicts of interest, The Des Moines Register reported.

Roberts is a former Iowa state legislator and Republican gubernatorial candidate who has sat on the board of the New Hope Village care center and its charitable foundation, in Carroll, IA, according to the news outlet. His wife, Patricia, worked at St. Anthony Regional Hospital and Nursing Home in Carroll for about 17 years. Now, she is the director of development for a foundation that gives St. Anthony financial support. Additionally, Patricia Roberts works for a lobbying organization in support of Iowa hospitals, according to the paper.

When Branstad was running for governor, he made statements on Iowa Public Television criticizing Iowa's nursing home regulators, accusing them of having a “gotcha” attitude with regard to reporting nursing home code violations. He said that if he were elected, he would replace Dean Lerner, the current head of Iowa's Department of Inspections and Appeals, a nursing home regulator.

Earlier in 2010, Roberts helped introduce a bill that would cap the damages awarded to patients who were injured or died because of facility care.

A spokesman for Branstad says the governor-elect is certain there are no conflicts of interest between Roberts and his involvement in the nursing home industry.

SOUTHEAST
Troubled homes get help
GEORGIA—Struggling nursing homes in Georgia and three other states are getting some assistance from a pilot program funded by a grant from the Commonwealth Fund to the American Association of Homes and Services for the Aging.

Operated under the sponsorship of Advancing Excellence in America's Nursing Homes, the program aims to increase consistent assignments as a way to reduce employee turnover and improve resident satisfaction. Nursing home reformers involved with the program would like to decrease the number of caregivers per resident from 22 to eight, according to news reports. To qualify for the program, a nursing home must be in an urban area with a high minority population on Medicaid who must have serious health problems. Illinois, Ohio and Indiana are also involved in the program.

The voluntary program is available to nursing homes that have dealt with regulatory problems involving quality.

NORTHEAST
Antipsychotics task force
MASSACHUSETTS—State nursing home regulators, in conjunction with providers, launched a campaign in mid-November to decrease the use of antipsychotic medications in dementia patients. The use of these medications, regulators say, is higher in Massachusetts than in other states. Throughout 2011, teams of specialists will identify nursing homes that have successfully avoided overuse and which ones need more work.

Some experts who study this issue claim that understaffing is a factor in the high rates of antipsychotics. They also say that frontline workers, including nurses, are unaware of the black-box warnings on some of these drugs.
In 2009, a series of Boston Globe investigations found that 22% of the state's nursing home residents with prescriptions for antipsychotics were using them for off-label indications. As a result, Massachusetts has the twelfth-highest rate of misused antipsychotics [in nursing homes], in the United States, the Globe reported.

WEST
Reward system worrisome

CALIFORNIA—Eldercare advocates worry that offering California nursing homes monetary incentives to improve care and staffing would boost the bottom line—but not the quality of care.

Officials from the state's Department of Public Health and the Department of Health Care Services are working on a plan that would use $40 million in Medi-Cal rate increases in the state's pay-for-performance plan.

The state would evaluate nursing homes on five standards of care—such as ratios of nurses to residents, minimizing physical restraints and bedsore prevention. High-performing nursing homes based on such standards would receive bonuses.

Advocates of the incentives contend that setting higher standards would drive facilities to improve care. Critics say it would reward homes that already perform well, leaving troubled nursing homes stuck in the same spot.
Furthermore, they say the formula for rewarding homes wouldn't penalize facilities that use antipsychotics to restrain residents.

The formula also wouldn't block bonuses to homes that have been cited for abuse or neglect, critics insist.

Northwest
Healthcare workers needed

ALASKA—Like other states, Alaska is struggling to keep up with a rapidly aging population. But the large number of vacancies for healthcare workers is troublesome. Also, the situation could worsen unless Alaska retains more doctors and nurses, statistics show.

As of the end of 2009, a report from the University of Alaska found that 10.2% of registered nurse positions were vacant in surveyed healthcare providers. Moreover, statistics from Alaska's Department of Labor and Workforce Development reveal that in order to keep up with demand for services, the state will need to expand its healthcare workforce by 28% within the next 10 years.

The state's healthcare administrators admit that Alaska's remote location and lack of urban infrastructure make it difficult for the state to recruit healthcare workers from the “lower 48” states.

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