Janet Glueckstein, being assisted by a Passport case manager, calls her one-month stay in a nursing home 'horrible.' (Tony Jones photo) | ZOOM |

        COLUMBUS — Ohio shells out millions every year to nursing homes to pay for beds and health-care services many older Ohioans never use.

        Records reviewed by The Cincinnati Enquirer show seniors increasingly are opting to stay in their own homes with help from Medicaid instead of living in nursing homes. Last year, more than one out of every 10 beds the state tracks in Ohio's 980 nursing homes went unused on any given day.

        But while fewer seniors are using beds, state Medicaid payments to nursing homes — averaging $47,000 per bed — went up, not down. A bill passed this year by the Ohio General Assembly gave nursing homes a one-time boost of $16.2 million.

        That increase comes at a time when Ohio's Medicaid program, the government's medical safety net for low-income families, is struggling to cope with increased caseloads, skyrocketing prescription drug costs and other medical expenses. Things are so serious, state agencies are cutting $125 million from their budgets to help plug the state's share of a $648 million shortfall.

        Agency leaders and some lawmakers are pointing at nursing homes, which get $2.5 billion a year from Medicaid, as one place ripe for cuts. But they also acknowledge that could be politically impossible because the cuts could shut down some nursing homes.

        “Now we're all at a point where we recognize (nursing homes) are overbuilt,” said Joan Lawrence, director of the Ohio Department of Aging. “I'm not sure the industry realizes that.”

        Senate President Dick Finan, R-Evendale, agrees.

        “We have nursing homes at 50 percent, 60 percent capacity,” he said. “How long can you operate with those numbers?”

        Roger King, president of the Ohio Academy of Nursing Homes, said nursing homes need more money to provide the health and basic services state regulations demand.

        “Those costs don't change if you have 75 people in a 100-bed home instead of 95 (people,)” Mr. King said. “The government resents the bill they have to pay to care for the elderly.”

        At the center of the dilemma is a growing elderly population that is healthier and living longer. State agency officials say more seniors would choose to live on their own with a little help than move into nursing homes.

        “People's preferences are to stay in their own homes until they die,” Ms. Lawrence said.

        The Department of Aging runs the Passport Program, which offers Medicaid funds to pay for personal care, medical equipment, delivered meals and other assistance seniors might need to live at home.

        Statistics show Passport is growing fast — from 7,600 clients in 1992 to 24,250 seniors this year. Funding has more than tripled, from $60.2 million in 1992-1993 to just under $200 million this fiscal year.

        In Westwood, 83-year-old Janet Glueckstein lives in an apartment with her husband, Alfred, and with the help of a home health aide, a walker, wheelchair, a modified bathtub and a special mattress — all paid for by Passport.

        She used the word “horrible” to describe a month she spent recently in a nursing home recuperating from an illness.

        “They've been wonderful for me,” she said of Passport caseworkers. “Anything I need they seem to come up with.”

        Meanwhile, nursing home occupancy rates tracked by the Ohio Department of Job and Family Services have fallen from 94 percent in 1991 to 87 percent in 1999. That means 13 percent of the long-term care industry's 120,000 beds are unoccupied at any given time.

        “The bottom line is the market is changing,” said Harry Saxe, chief of Long-Term Care Facilities for Job and Family Services. “People are demanding other settings in which to live.”

        Mr. Saxe and Ms. Lawrence believe there are now too many nursing home beds in the Medicaid system.

        “There is a need for some right-sizing of the industry,” Mr. Saxe said.

        Ms. Lawrence said the savings to the state would be dramatic. She said Passport costs about $8,800 per person, per year, compared with the $47,000 the state pays for each nursing home bed.

        Despite this trend toward more in-home care, the General Assembly passed a bill intended to help nursing homes keep their money and get a little more.

        The proposal altered a complex formula the state uses to pay nursing homes. That formula reduces payments to nursing homes if their occupancy rates drop below 95 percent.

        The bill lowered that standard to 85 percent this budget year. It also raised the percentage of nursing costs that homes could claim.

        The end result, according to the Legislative Budget Office, was a one-year $16.2 million increase in Medicaid funds paid to nursing homes.

        The sponsor of the bill, state Rep. Pat Tiberi, R-Columbus, said the increase was necessary.

        “I thought the (funding) formula was unfair,” Mr. Tiberi said. “It seemed to me that what we were doing was putting some fairness back into the system.”

        Gov. Bob Taft signed the bill, he said, with reservations.

        “Right now the formula is favorable to (nursing homes,)” Mr. Taft said. “But ... there is no increase in demand at this time.”

        Mr. King said nursing homes have become a scapegoat among politicians looking to cut costs.

        Nursing homes, he said, face a national shortage of nurses and health-care professionals that is driving salaries and related costs through the roof. Other costs that cover nursing home administration, maintenance, electricity and property taxes also continue to rise.

        On top of that, he said, a $365 annual tax the state imposes on every nursing home bed actually helps fund the Passport Program.

        The tax, which amounts to about $21.2 million a year, forms a small portion of the state and federal funds Ohio spends on Medicaid.

        “They tax us in order to reduce our occupancy, and then they punish us for reducing our occupancy,” he said. “It's faulty, disjointed policy. Nursing homes are stuck in the middle trying to deal with everybody.”

        The one-time funding increase, Mr. King said, was needed to help nursing homes stay afloat.

        Mr. King also said nursing homes and state officials face a future in which more and more Americans will become senior citizens in need of these services.

        “I think we have a lot of people in political office who do not understand the whole picture,” he said.

        Sen. Merle Kearns, R-Springfield, chairwoman of the Ohio Senate's Human Services and Aging subcommittee, said she hopes to push for some changes in the system next year.

        “The reality is that many people do not have a need for nursing home beds,” Ms. Kearns said.

        “There probably are facilities that need to reduce their number of unoccupied beds,” Mr. King conceded. “But what do we do about the 75 people who still live in a facility? Do we financially cut them off? It can't just be one-sided.”

        One thing is certain. Medicaid costs, including prescription drugs, figure to remain a huge problem for lawmakers and state budget officials.

        The state struggled to find the money needed to fill a $648 million Medicaid shortfall this year. Lawmakers expect Medicaid bills, driven up by prescription drug prices and other increasing medical costs, will dominate next year's budget negotiations.

        Seniors account for only about a third of the low-income individuals served by Medicaid. But that relatively small group accounts for about two-thirds of the money the state pays out.

        Considering that, Ms. Kearns said changes are on the horizon for nursing home payments.

        “You've got to have some kind of balance.”

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