Nursing home care different today from yesterday

December 4, 2011

By Dan Petrella and Pam G. Dempsey/CU-CitizenAccess -- Nursing home care is much different today than it was a decade ago.

“Assisted living, supportive living (and) home health options have certainly made a big change within the last 10 years,” said Ben Craft, social services director at Colonial Manor in Danville.

Instead of nursing homes becoming a final, permanent home for the elderly, they’ve transitioned to a temporary home used for recouping from surgery or an illness for a majority of senior citizens.

“All in all, the business of long-term and helping our seniors changed,” Craft said. “We’ve switched over from being a traditional nursing home to being a more acute center for therapy and (then) turn around to get (patients) back into their home environment.”

Colonial Manor admits an average of 25 to 30 patients a month and discharges about the same. The average length of stay is between two and three weeks, Craft said.

Greg Wilson is vice president of quality management for Petersen Health Care, which operates dozens of for-profit nursing homes across the state.

“We have seen a steady increase in the acuity of our residents. Nursing homes used to be more or a ‘board and care’ end of life option,” wrote Wilson in an email.

“Long term care has evolved into a very highly skilled rehabilitation environment both for physical and occupational therapies as well as a highly skilled nursing environment.”

Yet the need for long-term care is still there.

Because people are waiting longer to transition to nursing homes, they are often sicker, said Chris Kasper, administrator of Country Health Care and Rehab in Gifford.

In fact, the thought of going to a nursing home can be traumatic for some people, he said.
 
“There’s always been this fear out in the community about nursing homes,” Kasper said.

Colonial Manor resident Eunice Chapin, or “Butch” to her friends and family, shared the same hesitations.

Now a permanent resident of four years, Chapin said she once visited an aunt at another nursing home and found it “sad.”

But now, “nursing homes are different. I don’t know anybody that complains about a nursing home … I really don’t,” Chapin said.

Chapin, 88, came to Colonial Manor following a hospital stay.  

“I was a widow and I couldn’t take myself any longer so I knew I had to go to someplace where I could be taken care of,” Chapin said.

Chapin currently occupies a private room filled with books, photos and mementos. She said she’ll stay in her private room until her money runs out. Photo by Darrell Hoemann LPNs Jill Zimmerman and Meghan Davis review resident charts and contact doctors at the Country Rehab & Care Center in Gifford on Monday, Nov. 28, 2011

I like “the security and knowing there is somebody here that will take care of me if I need it,” she said.

The cost of care is an issue administrators and patients grapple with often.

At Colonial Manor, the average daily cost of care is about $140 for short-term patients.

Medicare will pay a maximum of 100 days of nursing home care, but in 20 day increments, Craft said.

Administrators will work with patients who may not have supplemental insurance to either get them in the best shape possible for release or help them find additional funding.

“As an industry we have seen a huge increase in costly state and federal regulation without a corresponding increase in reimbursement,” Wilson said in an email.

Wilson said that Illinois has the lowest reimbursement rates in the country.

“In 2010, the State of Illinois average Medicaid daily rate for providing 24-hour nursing care, housing and meals was $118 - approximately $30 less than the actual cost of that care,” he wrote.

“The national average daily rate was $172.16. Illinois was $54.59 a day below the national average.

“The system makes no accommodation for the wide disparity between Medicaid reimbursement rates paid throughout the country of which Illinois is historically ranked at the very bottom,” Wilson wrote.

There are always additional costs involved when accepting government-aid payments, such as paperwork, and even more so for Medicaid, said Deb Reardanz, president and CEO of Clark-Lindsay Village in Urbana.

Accepting Medicaid, “as a business decision, it doesn’t make sense for us,” she said.

Some nursing homes cut corners or close down because of delay in state payments for care, Kasper said.

The key is to have a mixture of both private pay and public pay patients, he said.

“We don’t cut staff. We don’t go to cheaper supplies. We don’t, you know, try and cut corners or anything like that because in the end, regardless, it might save our bottom line, but who does it affect? And that’s what it comes down to," Kasper said. 

“You have to provide a good product, and you have to show that it isn’t about the money. It’s about taking care of the resident and I think we do a stellar job doing that.”