Nursing Homes Versus Home and Community Based Care: What’s Wrong With This Picture? 

Nursing homes have been draining Louisiana’s resources while people with disabilities wait inordinate amounts of time for services in the community.

Fact:  Louisiana keeps spending more on a service that people don’t want

Over the past 11 years, despite clear evidence that people with disabilities have the right and the desire to live and receive services in their homes, Louisiana has maintained, and even increased spending on segregated nursing home services. During these same 11 years, demand for nursing homes services has dwindled.The population private nursing homes in Louisiana has decreased from 34,727 in 2000 to 29,392 in 2010.  Yet, during that time, spending on private nursing homes has increased from $503,762,909 in 2000 to $737,529,166 in 2010.  An additional $20,735,439 was spent on the two State nursing homes in 2010.

Nursing home rates have increased in every year since at least FY 2003, even as numbers of individuals served in nursing homes have steadily declined.  In SFY 2011, the nursing home Medicaid per diem reimbursement was increased by approximately $8 per patient per day or 8.5%.  Annually, Louisiana’s long-term care budget includes over $23 million in payments to nursing homes for empty nursing home beds.

Fact:  Louisiana is cutting the services that people DO want 

At the same time nursing homes are seeing these increases in spending, the Louisiana Department of Health and Hospitals is cutting Long Term-Personal Care Services from 42 hours a week to a maximum of 32 hours a week, with no exceptions to prevent unnecessary institutionalization, and no plan to assure people access to services in their homes.  These reductions fall most heavily on the most vulnerable group of people with disabilities-those who have the most severe disabilities and the most critical service needs.  When individuals in need of personal care assistance do not have enough help, they are at risk of going hungry, experiencing dehydration, and suffering injuries due to falls, burns, bedsores, and contractures. Inadequate levels of help reduce the ability of people with disabilities to live independently and increase their risk of institutionalization and death.

Fact:  Louisiana’s spending on nursing homes versus community-based care is way out of balance       

In 2011, Louisiana will spend approximately 73% of its Medicaid long- term care budget on institutional nursing home services and only 27% on community-based services. Louisiana has one of the highest, if not the highest, number of nursing home beds per capita in the nation, and institutionalizes a higher percentage of its population over the age of 85 than any other state. 

In 2009, Louisiana had 14,163 people on waiting lists for its aged and disabled adults waivers and ranked 38th in per capita spending on home- and community based waivers for the aged and disabled, expending only $15.85 per capita.

Fact:  Home and community-based services are, overall, less expensive than nursing home care

Home and community based services are cost-effective. For example, the average cost of services for a person on the LT-PCS program is considerably less than the cost of maintaining a person in a nursing facility, and it has been so since the inception of the program.

Despite these facts, home and community based services have been cut dramatically. Rates paid provider agencies for LT-PCS services (which include all overhead, employers’ share of taxes, workers’ compensation premiums, training, and recruitment costs, as well as direct care worker salaries), have been reduced 17.4% since February of 2009 and remain far below the national average.

So, to summarize, in a time of immense deficits, Louisiana continues to buy the Cadillac services people don’t want instead of the Ford people do want.  Why?  Maybe you should ask your legislator.

For more information on Louisiana’s long-term care expenditures, click here.