A Call to Action - A Show of Support is Needed
In an attempt to bring public and media attention to the stalled budget and the harsh impact that the payment delays will have on providers of services for persons with developmental disabilities, SDHCA is mounting rally on Thursday at 10:00 a.m. in San Diego. We want CAHF Members to gather in front of Senator Denise Ducheny District Office. The address is 637 3rd. Avenue, Chula Vista.
CAHF is asking that the DD providers take the lead at this rally, and that the SNF members be in attendance to lend support to not only the plight of the DD providers, but also to push legislative leadership to get to work and pass a budget. If this budget impasse continues SNF providers will also be impacted.
For more information please read on -
Impact of a delayed budget and scheduled payment delays on providers of services for clients with developmental disabilities
BACKGROUND
• In February, the Legislature approved, and the Governor signed, several emergency “budget-balancing reductions” to address the state’s unprecedented state deficit. One of these actions directly impacts California’s approximately 1,200 facilities serving people with developmental disabilities. These facilities are small homes serving six or fewer people.
• The facilities serving people with developmental disabilities (DD) are 100% funded by Medi-Cal.
• The emergency reductions will defer Medi-Cal payments for the month of August this year for all Medi-Cal reimbursed facility providers serving people with developmental disabilities. This payment delay will occur regardless of when a budget is enacted.
• For a typical home serving 6 people, this delay translates into an average total loss of income of $32,000.00 per month.
• On top of the scheduled payment delay, the fund that is designed to provide interim payment for Medi-Cal providers when a budget is late is expected to be depleted by July 21. That means no more Medi-Cal payments until a budget is enacted.
THE DEVESTATING REALITY
• The “planned” payment delays, coupled with delays in the enactment of a budget could result in providers serving California’s most vulnerable people being asked to “keep their doors open” and continue to pay their bills (wages, benefits, taxes, utilities, food, insurance, etc.). As a result, such delays will be more devastating for these providers and the people they serve than for anyone else in the system.
• These small businesses cannot cope with a loss of Medi-Cal payments for an extended period by shifting costs to other payers or generating revenue from alternative sources, because they have no other payment sources.
• As 24 hour care providers, they cannot reduce services or close their doors without placing people in potential jeopardy.
• These providers operate small homes, generally serving six people with developmental disabilities. These consumers require continuous nursing and professional staff attention for complex and chronic medical and pervasive developmental/behavioral challenges. Because of this, they cannot safely reside in settings without 24/7 care by specifically trained staff who know them and can anticipate their needs.
• Many of these providers have already borrowed against their property or on have taken out unsecured lines of credit using credit cards. In an already compromised credit market (largely due to the mortgage crash and real estate devaluation), many of these providers will not be able to secure the loans necessary to meet expenses and survive payment delays, let alone additional payment delays from a State budget stalemate. Those that can borrow will pay exorbitant interest rates for the money borrowed.
• More recently, the lack of rate increases sufficient to keep up with inflation and new mandates such as the minimum wage; have put this provider group at the brink of financial catastrophe, even before the payment delay.
PEOPLE WILL BE DISPLACED
• Given the shaky financial stability of this provider category, the payment delay will result in forcing some providers out of business. The people living in homes that close will suffer the loss of their home, their friends and care provided by the people who know them best. Where will they go? Perhaps to a facility in another city, or to a State Developmental Center. These fragile individuals, without a voice, will suffer trauma due to these transfers and pay the highest price of all.
COSTS TO THE STATE WILL BE SIGNIFICANT
• Consider that If there were a 1% failure of these facilities (in this example, 12 facilities close), if just 72 residents were displaced and forced to return to State Developmental Centers, this could cost the State more than 16 million dollars in additional costs. The annual cost for care for a small community based home serving six people, is $64,000.00 per person. Care for that same person residing in a State Developmental Center is $290,064.00.
JOBS WILL BE LOST
• As these facilities close or cut non-essential staffing positions, local jobs will be lost. The typical staff person providing direct care and services is a single mother who is a lower income wage earner. These workers will be dumped into the job market and struggle to find other employment. If they fail, they will be forced to use unemployment benefits.
If you have questions, please call Joe Diaz at 1-800-824-7074
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President’s Update: LTC in China
In October 2007, I arranged a tour to China. As President of San Diego Health Care Association, I coordinated visits to two nursing homes with the help of China Spree Tours. A total of 36 people consisting of SDHCA board officers, members of CAHF including Parkside Special Care’s Medical Director, Andrew Alongi, M.D. and Sandra Lourido, R.N., Kennon S Shea & Associates participated. We visited the Beijing Social Welfare Institution #1 and the Zhongren Nursing Home near Shanghai. In addition to seeing the many treasures in Beijing, Xian, Shanghai and Suzhou, we were also given a tour of a Kindergarten School in Beijing’s Hutong district and a Blind Massage Hospital.
Our first stop in Beijing was to the Social Welfare Institution #1. It is a 500 bed hospital complex which includes acute care, independent and assisted living as well as a 140 bed skilled nursing unit. We were greeted cordially by Jiaso Yu Fen, Assistant President of All-China Women’s Federation who had arranged the tour of the hospital. We were invited into a beautifully appointed conference room where we were introduced to Mr. Zhang Fu Xing, the Administrator. Following a brief video introduction to the center we were allowed a question and answer period. We discovered many similarities in direct care delivery. An interesting observation was that a meal cart was rolled through the halls at meal times and served individually to each one room studio apartment. Numerous video monitors were contained within a room to track the movements of residents and visitors.
Near Shanghai, we visited the Zhongren Nursing Home. It is a beautiful 400 bed facility. Since our plane touched down three hours later then planned, we arrived at the nursing home very late. Several residents who seemed to know we were coming greeted us in the lobby. The Administrator and Director of Nurses had waited until 5:00 pm but had to leave. However, the resident physician was very gracious in providing a tour. She seemed very proud of the opportunity to show 36 people through the hospital. The resident rooms were very clean but sparse in furnishings. We were somewhat surprised by the use of bed restraints in addition to full side rails. The residents appeared to be well cared for. There was no evidence of skin breakdown. The residents receive a combination of western styled medicine as well as eastern style. Daily massage therapy is available to all residents as well as acupressure and acupuncture when needed. The public areas are large with comfortable furnishings. I presented to the elders at Zhongren Nursing Home a plaque on behalf the San Diego Health Care Association. It was a great photo opportunity for the elders, the “Aunties” (equivalent to our C.N.A.s), the licensed nurses, physicians on staff and our group.
The Blind Massage Hospital in Beijing was also a highlight of the trip. Blind people throughout China are given an opportunity to apply for entrance to the massage school. Who better could be trained to provide therapeutic massage then people who “see” with their hands? We were given a behind the scenes tour by Ms. Yang Yang, the Director. One of the instructors, who is blind and spoke excellent English, gave us a history of the school, the clinic and the treatment modalities. The founder of the school was introduced to us. Through an interpreter we learned he founded the school 40 years earlier. The Clinic sees approximately 1000 people a day. They are open 7 days a week from 7:00 am to 10:00 pm.
The visit to the Kindergarten in the Hutong District in Beijing was fun. The children seemed very happy to see us. Every child was able to say “thank you, very much” in perfect English when they accepted candy from us. In the lobby of the school, there was a tree filled with flash cards of different fruits with the English name. All children are taught English beginning as early as kindergarten. We learned that some children come to the school daily and others stay Monday through Friday and go home on weekends to be with their parents.
Our China Spree National Tour guide, Ming Li commented that she found our groups’ itinerary among the most interesting she had ever experienced. She felt she had learned so much about her own country’s ability to care for the very old and the very young. She stated she would be forever grateful to our group for planning this special tour. Because of Ming’s expertise, knowledge and tireless enthusiasm, our trip was one not to be forgotten either.
Zhongren Nursing Home, Shanghai - from left to right: 2 residents, Caregiver (hidden in green), Loraine Wiencek, Administrator, Nancy Beecham, DON, Mary Norwood, Administrator, Zhongren Licensed Nurse, Zhongren Physician, Ed Long, Aministrator and President of SDHCA and the Resident Physician in Charge of the Zhongren Nursing Home
Ed Long, President
San Diego Health Care Association
November 5, 2007
Posted by elong as President's Update at 6:35 AM PST
