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Friday, July 22, 2011

Marcus Paints Bleak Picture of Gracedale, Human Services, in Meeting With State Legislators

Bob Freeman, Marcia Hahn & Julie Harhart in Star Chamber
As a County-owned nursing home, Gracedale gets less money from Medicare and Medicaid than it would if it were privately owned. Last year, it received $4.3 million less. In 2009, it was $3.1 million less than would be paid to a private owner. So after the May plebiscite in which voters decided, 3 to 1, against a sale, one of County Council's first moves was to invite state legislators to discuss those reimbursement rates. That meeting finally happened yesterday, at a combined Intergovernmental and Human Services Committee chaired by Peg Ferraro. And legislators came.
State Rep. Bob Freeman was there, along with Joe Emrick, Marcia Hahn and Julie Harhart. State Rep. Joe Brennan sent Matt Recker, and State Senators Pat Browne and Bob Mensch had aides on hand as well. But instead of turning on the heat on an already hot day, it took Human Services Director Ross Marcus most of an hour just to lay out the problems. Unfortunately, they go well beyond Gracedale and into other areas of Human Services.

Peg Ferraro set the tone. "The more I study this, the less I seem to know," she said at the onset. I thought that was an incredibly ignorant thing to say, but as the meeting progressed, I was forced to agree.

Reimbursement Rate Changes

As Marcus explained it, these changes first occurred when the 2006-2007 state budget was adopted. One reimbursement formula is used for government-owned nursing homes, while another and higher rate is paid to privately-owned facilities. Governments were frozen at the rates that existed in April 2006, although there have been cost of living adjustments.

Private nursing homes tend to get more money, but it's more complicated than that. Their reimbursements are based on their "case mix," in which patients requiring skilled care qualify for higher rates than those whose needs are more basic.

As an example, Marcus mentioned Alzheimers' patients. They do poorly if reimbursement is based on a "case mix" formula because the demand for skilled care is low. As a result, private homes have little incentive to admit these patients. A government-owned nursing home, reimbursed under a different formula, might actually do better for that type of patient. So the argument is that this different rate will enable the County "to remain true to its mission."

But overall, counties are compensated less than privately-owned homes.

Although state legislators spent most of their time listening, Bob Freeman did note that new legislation gives the Secretary of DPW "sweeping power" to set rates, so things could actually get worse. But as things stand, reimbursement rates are essentially frozen, prompting Joe Emrick to ask, "You said this was to protect the County home?"

It's confusing, and after hearing Marcus explain that the County can get a "case mix" reimbursement for certain types of care, he seemed even more mystified. "It's a very complicated thing."

Quality of care at Gracedale Praised

Ross Marcus told legislators that Gracedale budgets 3.2 hours of nursing per resident per day. Bob Freeman noted he deals with many seniors who tell him that if they have to go to a nursing home, they want it to be Gracedale.

Is More Parity Possible?

Before the meeting was over, Mike Dowd asked legislators "to even the playing field. The taxpayers have to have some relief." Ferraro echoed Dowd. "Just bring us a little more parity," she asked. Although legislators do have the power to make changes, Julie Harhart noted that the budget for this year has already been adopted. So even if relief is possible, it's at least a year away.

And is relief possible? After the meeting, several legislators told me the numbers they get are not the numbers they are hearing from the County.

Cuts Extend Beyond Gracedale.

Unfortunately, state funding cuts begin, and do not end at Gracedale. Marcus told Council members and legislators that the Human Services Development Fund has been cut 36-37 per cent in the most recent budget. Over the last few years, those cuts are 70 per cent.

Northampton County, like most other counties, paid for 10% of most human services. The rest was covered by state and federal government. But this year, Northampton County will pick up 26.5 per cent of the tab. And it has to do it or more children will be abused. Harhart seemed especially distressed by this revelation, and told everyone she is sponsoring a resolution to scrutinize C&Y programs

For mental health programs, the county contribution in 2012 will likely double. "It's not good news anywhere along the line," commented Marcus.

The Area Agency on Aging, which provides home health care, senior centers and other services that allow the elderly to remain in their homes, is a shadow of its former self. Marcus told everyone the picture "is bleak," with almost no match to the County. For many year, the County was kicking in $300,000 to 400,000 annually. Executive Stoffa increased the allocation to $800,000, but has been forced to reduce it to $600,000 as a result of other budget demands.

Council members Mike Dowd, Bruce Gilbert, Peg Ferraro, John Cusick and Tom Dietrich particaated in yesterday's meeting, along with Executive John Stoffa.


Anonymous said...

The 10% statement was not entirely factual. Frankly, Mr. Marcus knowledge in this area is sadly lacking. That is an unfortunate situation for Northampton County and this Department.

county insider

Bernie O'Hare said...

So you say, but you do not identify yourself and Marcus does. I'm sure we'd all like to know more than we do. One of the things I know is that it is inherently unfair to attack someone without identifying yourself. Cowardly, too.

Anonymous said...

A live Bob Freeman sighting and it's buried in the story? You had a scoop.

Lighthouse said...

Trying to better understand the reimbursement problems decribed here by Mr. Marcus, I just skimmed through the CHR report of July 2010, mainly looking at what seemed the relevant Medicaid/CMI parts pp33-37, and 47-50. Both helpful, yet still a little confusing for a layman.

Fearing I am venturing over my head due to lack of background knowledge, I'll keep my question simple: in today's newspaper, Atiyeh was approved for another Alzheimer facility (Forks). If "private homes have little incentive to admit these patients", how does Abe have facilities around the Valley, since he wouldn't be doing it if it were not profitable?

Anonymous said...

Observations from reading this blog:

"private homes have little incentive to admit these patients" appears to be either 'old logic' or a scam.

With the current reimbursement rates, private get more taxpayer funded money from the state than public run facilities, this has been stated many times on this blog. When a nursing home is county owned, with medical assistance patients, it loses money till it is sold. After sold, the new private owner reaches out and grabs up medical assistance patients like crazy. A point made in this blog, after the sale medical assistance patient numbers increase, when compared to county ownership.

So why are state tax payers' money sent to these PRIVATE homes, even after years of proof it's hurting public homes? Lobbyists?

Anonymous said...

Dear 1129,

Yes..Lobbyists..Lobbyists who donate tons of money to the Governor and his friends in hopes that they'll privitize everything..
Luckily for these lobbyists, the Governor is continuing to do their bidding..And what happens to these private facilities when all the public homes are closed and the Medicaid well runs dry..They'll shut down because it's no longer profitable..Then where do all the seniors go? Ooops, nowhere, since all of the Counties closed their facilities down...

Anonymous said...

Lobbyists give a voice to millions of patients who choose private care over the lowest common denominator scheme run by inefficient governments trying to protect union jobs at the expense of patient care. SEIU is a powerful lobby representing its members. Gracedale is routinely rated poor for a reason. Privates are consistently rated better. People vote with their pocketbooks and most don't want a government that can't fix potholes caring for their loved ones. Enough tax money is wasted keeping these dinosaurs open and operating. They receive enough taxpayer money.

Anonymous said...

Abe has private pay homes around this area. I am almost 100% sure there is not medicare and medicaid reimbursing him. Personal care homes are not nursing homes because they dont require licensed nurses, and the regulations are different. He profits easily because he pays shit wages to people he hires off the street, and collects a handsome monthly rent from his patients

Anonymous said...

Private nursing homes pay plenty of taxes. If some of that comes back to them as an incentive, and is unpredictable v. a fixed rate given to county homes than so be it. The private homes pay local, county, state and school board taxes. So they do not have a level playing field either against the county homes who are tax-exempt.

Anonymous said...

Lighthouse, not all of these statements are accurate. Employees cannot say to much, this administration isn't exactly employee friendly, as to job security. Not all the statements made by Mr. Marcus are factual.

Even Mr. O'Hare is deleting our posts. so you can see we are a bit nervous. Nervous yes, hard working yes, cowards no!

Anonymous said...

This mess at Gracedale took place under the watchful eyes of the Bulldog and his other co-horts on Council, County Executive Stoffa, and Human Services Director Marcus. You said over the last six years. What a legacy.

Anonymous said...

If lobbyists were the influence for stiffing public nursing homes of money, it was done in 2006; so it was Rendel's crew that was bought by them.

Anonymous said...

If lobbyists were the influence for stiffing public nursing homes of money, it was done in 2006; so it was Rendel's crew that was bought by them.

Anonymous said...

I blame Jimmy Carter and Harry Truman!

TriCornered Tim!

Zorn said...

sell the albatross which is nothing but a semi glorified poor house and sanctuary for greedy union pukes

Anonymous said...

Zorn are you retarded or just special needs?