Medicaid reimbursements and keeping quality help are challenges for nursing homes

By Rozella Hardin

   The modern American health insurance system has made life difficult for many people on both sides of the stethoscope. And while we might hope that the difficulties would shrink as we age, such does not appear to be the case.
   As administrator of Hermitage Nursing Home in Elizabethton, Jeanette Bradshaw is attuned to the ways and means of modern health care. And though she strives to give her clients the best of everything, Bradshaw says that it is becoming increasingly more difficult for nursing homes to meet residents' needs and even to stay in business.
   "We strive to be perfect; to give quality care," said Bradshaw, whose nursing home fared well on its latest inspection, with no health deficiencies reported for the year ending Dec. 31, 2002.
   Compared with other nursing homes in the county, Hermitage had the least number of health deficiencies. Hillview registered five; Ivy Hall, four; Life Care, 11; Pine Ridge, 11; and Roan Highlands, 12. This is according to the Nursing Home Comparison Report on the Medicare Web site.
   "We are a very regulated industry, and they (the government) just keep asking for more and more," Bradshaw said, noting that inspections are very thorough.
   As part of the Social Security/Medicare Law, every nursing home in America is inspected annually, and has been for years. The inspection report includes everything from how health and safety violations were found to how many nurses aides are in training at each facility. All of which is very useful information for persons selecting a nursing home for members of their family.
   Bradshaw has been at Hermitage for over 30 years. In her years of experience, she has seen and dealt with many types of clients and facilities, and despite the hardships of the industry overall, feels very fortunate to be at Hermitage. "We are small, and we try to do the best we can with what we have," she said.
   She was very complimentary of the quality of employees who work at Hermitage. "We have some fine employees, and they do work hard. It is hard to find the right employees for nursing home work. But, we strive to find quality employees, because not everyone is cut out for nursing home work. It takes a special person to work in a nursing home," she said.
   Regulations and re-imbursements are two of the biggest challenges nursing homes, in general, face, opined Bradshaw.
   What do families look for in choosing a nursing home? Debbie Street, assistant administrator at Pine Ridge Care Center, believes it is quality of care, as well as a number of other qualities including cleanliness and appearance and the friendliness of the staff.
   Bradshaw agrees that appearance goes a long way. "I think when people visit a nursing home, they look at the appearance, the quality of care, and they look at the residents to see if they are happy," she said.
   Nursing home care costs can range from $2,000 to $4,700 a month. The financial impact of long-term care can be almost as formidable as the illnesses that necessitate nursing home admission -- primarily because few people are prepared for it.
   The majority of nursing home patients in Tennessee receive government aid to pay for their nursing home care -- mostly through Medicaid. In fact, 74 percent of the state's long-term care patients receive Medicaid benefits.
   The program originally was not designed to serve the elderly long-term care population; however, currently it is the primary method of financing nursing home care for those individuals who cannot afford to pay for it.
1. Physical Appearance -- Take a look around at everything. Is there a lounge or other area where residents can entertain visitors privately? Is there an out-of-doors area where residents can walk or sit, and is it used? Does each resident have at least one comfortable chair? Does each resident have his/her own dresser and closet space with a locked drawer or other secured compartment?
   2. Safety -- State standards require that a home provide a safe environment for residents whether they are mobile or in wheelchairs, whether they are confused or have poor eyesight. Look for handrails in hallways; wide, clear walking areas; good lighting; clearly marked exits, etc.
   3. Cleanliness -- A good home should be clean. Look in the corners of residents' rooms, bathrooms, kitchens, nurses stations, etc., as well as in the main visiting lounges. Look for cleanliness everywhere.
   4. Residents -- The average nursing home resident is old, sick and frail. A good home is aware that even frail elderly people can have good days and bad days and can be encouraged to be more active when they are feeling better and comforted when they are feeling poorly.
   5. Food -- Mealtime is an important part of the resident's day. Try to visit during mealtime and observe the way the food is served and how the staff and residents interact.
   6. Activities -- All homes are required to offer activities for residents. As you visit homes, you may find a great difference in the way activities are offered. Ideally, a program should be designed to fit the interests and skills of each person and be available on a daily basis at various times of the day including weekends.
   7. Medical/Nursing Care -- It is hard to observe medical/nursing practices, but you can ask questions. Does the same nurse or aide care for the resident during each shift? Will your family doctor be able to care for your family member in the facility? If not, who will the physician be? How often will visits be made? How will emergencies be handled?