Skagit Valley Herald (Mount Vernon, WA) March 1, 2020
Mar.
1--The five skilled nursing facilities in Skagit County are among those
struggling to survive as the state's Medicaid reimbursements fail to keep up
with the rising costs of doing business.
"It's
impossible for us to stay afloat at the current funding," said Serge
Newberry, owner of Mira Vista Care Center in Mount Vernon. "We've tried as
much as we can to cut costs, but just like every other nursing home provider,
we're screaming for more reimbursement."
Newberry
said about two-thirds of his facility's patients are on Medicaid, which is the
shared state-federal health care program for low-income individuals.
"If
we were to take 100% Medicaid, we would go out of business," he said.
Low
Medicaid reimbursement rates have played a role in the closings of 20 nursing
homes in the state in the past three years, said Robin Dale, president/CEO of
the Washington Health Care Association, which represents the state's nursing
home industry.
In July,
San Juan Assisted Living in Anacortes reported it was in danger of closing --
which would have displaced 46 residents -- due to inadequate Medicaid
reimbursements. The facility was able to remain open after the state increased
its reimbursement rates.
State
legislators have proposed new funding this year to address the problem. Both
Democrats and Republicans from legislative districts that include parts of
Skagit County have said they support more Medicaid funds for skilled nursing
facilities.
Dale
said the additional funds may help prevent more closures in the short term. But
he said a long-term fix is needed to ensure Medicaid payments keep up with cost
of providing care.
Hardship
on businesses, employees
Newberry
said it costs the facility $271 a day to care for a patient, while the state
reimburses the facility $221 for each Medicaid patient.
Daily
Medicaid reimbursement rates are calculated based on each facility's 2016
reported costs.
Newberry
said that's a problem for nursing homes that have had to comply with mandatory
minimum wage increases and higher expectations for care.
"If
I have a restaurant and my costs go up, I could turn around and raise
prices," he said. "My costs continue to go up, but Medicaid
(reimbursement rates) don't."
Skilled
nursing facilities rely on patients with private insurance or Medicare to stay
afloat. Medicare pays more per patient per day, but only covers short-term
stays at nursing homes following hospitalizations.
At
Prestige Care in Burlington, Administrator Suzanna Weiler said low rates
sometimes mean the facility has to turn away Medicaid patients.
"I
probably have 25 on my waiting list," she said.
The
narrow operating margins have also hurt employees, who have seen their benefits
cut, Weiler said.
She
said it's unfair the facility is unable to offer better compensation than a
fast food restaurant.
"To
be a (certified nursing assistant), you have to go to school and it's a lot
harder work," she said. "You're doing a lot harder physical work and
emotional work."
Mike Shaw,
executive director of Life Care Center in Mount Vernon, said finding job
candidates is all the more challenging because hospitals can offer higher wages
for the same job.
"They
won't come here to be a support for residents if we can't give them a living
wage and if they have a family to take care of," he said.
In
danger of closing
The
state Department of Social and Health Services (DSHS) estimates the shortfall
between facilities' reported costs and Medicaid rates paid in 2018 was about
$116 million, department spokesperson Chris Wright said in an email.
If
there are no changes to Medicaid rates, the department expects that in 2020 the
shortfall will be close to $130 million, he said.
Dale
said the state's average Medicaid reimbursement rate is about $220 a day --
lower than in Idaho (about $260) and in Oregon ($320).
"If
you're losing between $35 and $45 a day for every Medicaid resident, that is
going to impact your ability to stay open," he said.
Another
nursing home -- Delta Rehabilitation Center in Snohomish County -- announced
earlier this month it will close.
When a
nursing home closes, DSHS is required to find new homes for the Medicaid
residents, Wright said. He said the department works with each individual to
move them to another skilled nursing facility, an assisted living facility,
adult family home or private residence.
Dale
said residents can suffer "transfer trauma" when they move to a new
facility.
"For
an acutely ill resident with even a moderate degree of dementia the move can
have a significant negative impact, particularly if family is unable to visit
as regularly as before," Dale said in an email.
New
funding
Skilled
nursing facilities may get some relief this year.
The
state Senate's proposed budget calls for about $43 million to be used to raise
Medicaid reimbursement rates, Wright said. The budget of the state House of
Representatives proposes less -- about $34 million -- he said. Both budgets
propose a one-time inflation adjustment to bring reimbursement rates up to the
cost of care.
"It's
a nonpartisan (issue)," said state Sen. Keith Wagoner, R-Sedro-Woolley.
"The House and Senate both want to put more into this. It's a matter which
number gets agreed on or if there's a compromise. It will be in the next couple
of weeks."
He said
the state will need to put more resources into skilled nursing facilities as
the population gets older.
"I
wish we got to this before 21 (facilities) closed," Wagoner said.
State
Sen. Liz Lovelett, D-Anacortes, agreed that Medicaid reimbursement rates are
too low, and worries about the impact on nursing home staff.
"It's
making sure staff are adequately compensated and (there isn't) a high level of
burnout of employees," she said.
Dale
said while temporary relief is welcome, a longer-term solution -- such as
adjusting rates annually instead of biennially, and an annual inflation
adjustment -- is needed to fully compensate facilities for cost of care.
Both
budgets would still leave a shortfall between costs and Medicaid rates of
between $106 million and $116 million, Wright said.
Dale
said another concern is that the scheduled rate increase on July 1 will be too
late for a few facilities that are barely making it.
The
Washington Health Care Association asked legislators to move up the rate
increase to May 1. Dale said that would address the jump in costs that occurred
in the first half of the year, such as the $1.50 minimum wage increase.
"(Two
facilities) are in danger of having to close between now and July 1," he
said.
A
growing need
DSHS
estimates that by 2040, the number of those over the age of 65 will reach 1.8
million and represent one-fifth of the population.
"With
a rapidly aging population, there will be a need for more providers of all
kinds over the next decade," Wright said in an email.
Dale
said the 21 closures come at a time when the state needs more skilled nursing
facilities, not less.
"There
is going to be a capacity issue in five to 10 years," he said. "Even
if (some) people go to home care and assisted living ...These (skilled nursing
facilities) closures are going to be a problem for us in a decade."
--
Reporter Jacqueline Allison: jallison@skagitpublishing.com, 360-416-2145,
Twitter: @Jacqueline_SVH
(c)2020
the Skagit Valley Herald (Mount Vernon, Wash.)
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