ELDER CARE: Area homes face shrinking revenue, staff

REGION – Though we may be tempted to fib about our age, the numbers don’t lie. Like it or not, we’re a “maturing” crowd. By 2010, the elderly population in the United States is projected to increase by 17 percent, from 33.5 million in 1995 to 39.4 million (13 percent of the population).

By 2030, the 65-plus population is projected to grow by 75 percent to over 69 million (20 percent of the population), according to 1996 Census estimates.

Members of the Northwestern Michigan Medical Care Facilities Coalition, an association of nine non-profit, county-run long-term skilled nursing care facilities, deal with caring for the aging population every day.

“The concept behind the Coalition is that as our reimbursement gets lower and lower, we as organizations have to find more innovative approaches to not having services harmed,” says Richard E. Marion, Jr., CEO of the Grand Traverse Pavilions and president elect of the Michigan County Medical Care Facility Council.

Capitalizing on economies of scale, or collaborative ventures among members in areas such as community education and purchasing, is one of the main thrusts of the group, he says.

According to the Coalition members interviewed, issues surrounding decreasing revenue, staffing and public perception of nursing homes are commonly faced by administrators.

Shrinking income

According to Marion, Coalition members work on a retrospective payment system, meaning there’s a two-year lag in reimbursement for costs.

“I think most of us would say it would be a challenge to balance our check books and make ends meet on our income from two years ago vs. current expenditures.”

Two years ago, Medicare reimbursement, which comprises about five to eight percent of the Pavilions’ constituent base, moved to a Prospective Payment System. The PPS is a capitated model based on acuity level, regardless of actual expenditures by the facility.

“Besides the cost (of losses), the assessment process to come up with the rates–there are 44 categories–is quite lengthy and cumbersome,” according to Penny Drury, administrator of Grandvue Medical Care Facility (MCF) in East Jordan.

Medicaid, comprising about 70 percent of Coalition members’ constituent base, has been moving toward a managed care model for long-term care for four years now, according to Marion. But it has yet to implement it.

“If that occurs, consumers will have to go to an HMO setting to access long term care services,” he explained.

A hefty price tag

For consumers, long-term skilled nursing care doesn’t come cheap. Often in the neighborhood of $150 per day, care can quickly deplete a family’s resources. Medicare only covers up to 20 days of skilled nursing care, and Medicaid eligibility guidelines are strict.

Another option, long-term care insurance, is underutilized. Dena Thompson, administrator of Manistee County Medical Care Facility has 102 residents right now and none of them have long-term care insurance.

“There’s a lack of education to the consumer,” Marion stated. “And it gets more expensive as you age. Being able to convince someone at a younger age to purchase it is difficult. We’d prefer to do other things with our disposable income, and we don’t think the future is as close as it actually is.”

Michigan will be undertaking a campaign in 2001 to educate consumers on the advantages of long-term care insurance, according to Marion. “If we were to incent purchasers with some tax relief, that would go a lot further in helping the concept pick up speed.”

The right people for the job

As in other service organizations, recruiting and retaining reliable staff can be challenging. Grandvue MCF joined the National Association of Geriatric Nursing Assistants about two years ago.

“Its whole focus is to educate nurses’ aides (Competency Evaluated Nursing Assistants or CENAs in Michigan) and to bring the level of understanding up regarding surveys, reimbursement and staffing issues, making them very savvy about their professions and improving self esteem,” says Drury.

In the past year, she’s seen a “different attitude” among CENAs. “I see them taking more pride in what they do.”

According to Marion of the Pavilions, “The challenge with staffing is cyclical in the marketplace. When there is lack of available employees for workplaces overall, it becomes more challenging to be able to recruit and maintain the number of employees you need.”

Thompson of Manistee agrees. “It’s very difficult to hire right now. It seems like everyone is working, and with the casino now, that took up a big pool of people.”

A better place to be

Grandvue MCF was recently added to the registry of the Eden Alternative. “It has huge potential to change the image of nursing homes and put a different focus on what life can be like there,” says Drury. “Residents have medical needs that need to be met, but the emphasis now is on quality of life, which is equally or more important.”

Residents at Grandvue can care for four-legged residents–four cats and a dog–or watch the 15 birds in the aviary. They can even have a caged bird in their room if they desire.

“People need to care for something, not just be cared for. That the cat needs to be fed can give someone a reason to get up in the morning,” says Drury.

Grandvue recently received a millage approval from the county, which will fund a renovation and addition that will start this spring. Plans call for additional space so that residents can be moved from four- to two-person rooms and so visiting families can have more personal space with residents.

In addition to facility enhancements, public education is key to changing the sterile image of nursing homes. The Pavilions provides meeting space to several area non-profit organizations so that community members can see “what type of organization we are and what goes on here,” says Marion. It, like other Coalition members, also has a speaker’s bureau. And the Coalition plans to continue outreach to the community via the Web by linking member Web sites and making them more accessible. BN