ElderLaw Podcast Transcript: Medicaid's Shortfall

We recently posted a series of ElderLaw Radio podcasts that discuss nursing home abuse, the problems that can lead to it, and the best ways to pursue a nursing home abuse lawsuit. We now bring you the transcript of these podcasts so you can read along while listening in.

In “Medicaid’s Shortfall,” Scott Plumb, the senior vice president of the Massachusetts’ Senior Care Association, speaks about the quality of care in the nursing homes his company represents as well as the looming problems involving resource allocation that he sees in the future that are being caused by Medicaid.

To listen while you read, click here to open a link to the podcast in a new window. Narrator: “This is an Elder Law Radio special report on nursing home abuse. Are your loved ones safe in our current system? And now, your host, Rachel Gotbaum.”

Rachel: “I’m Rachel Gotbaum for Elder Law Radio. I’m speaking with Scott Plumb – he’s the Senior Vice President of the Massachusetts Senior Care Association. The association represents more than 400 nursing homes across the state of Massachusetts. How has the industry changed over the years, and what have been some of the challenges you’ve seen in the last two decades?”

Scott: “There have been dramatic changes. Who we care for has changed quite dramatically. Twenty years ago we cared for essentially long-stay, custodial population who had some skill-care needs. That has been transformed dramatically in two ways. Number one: These people who were custodial care have been able to stay in the community longer. So they come to us later in their illness. So that’s one of our populations. A significantly new population are the post-acute rehab population. Nine in 10 of our admissions today come from the hospital.”

Rachel: “Let’s talk a little bit about the quality of care. Obviously they’re folks who work in reform, they’re residents who say - nationally - the quality has gone down. That people are more vulnerable to abuse, to neglect – and I’m wondering if you can speak to that.”

Scott: “I would say that the quality, and it’s not just me talking, alright, employee of the nursing home profession, saying this: I think the quality has gone up. The government - this is publically on record - is saying that the quality care on average in nursing homes in this country has gone up in the past decade – not down. So I would take strong issue with saying the quality in nursing homes nationally has gotten worse – I don’t think it has. I think it has the potential to turn back down significantly if what I see in the future, in terms of resource allocation, continues.”

Rachel: “So you talk about - nationally - care has gotten better. What makes you say that?”

Scott: “I think what’s happened is that more resources have been placed into long-term care, particularly here in Massachusetts, we’re staffing at higher levels than we used to staff at, we’re have more continuity in our staff, we have fewer vacancies, we’re better technically; I think we have many, many things today that we didn’t have 10-15 years ago that make us better caregivers. We’ve got far more transparency in our system; you could go online and there’s at least three or four different ways that you can investigate that measure the quality of care in nursing homes. Now they’re not by themselves, you know, what you should do when you’re making a decision about placing a loved one – but they’re very helpful.

We have a nursing home report card in Massachusetts that the Department of Public Health maintains. You go in there, you look at the nursing home, you can compare it to other nursing homes in its area; you can look at how they perform. So you have the nursing home report card. We have a consumer satisfaction survey process in Massachusetts. So I think we’re on average much better than facilities in other states. But I think if you look across the country, that the quality of care has gotten better; and the federal government admits this. It’s not perfect, I mean God knows, you know - we’re not perfect. We have at any period of time in Massachusetts, you know, a handful of homes who, you know, are having severe quality of care problems, who are on what they call “focus review”; they’re surveyed very frequently. So we’re not perfect.

It’s very important to have a reasonably high staff to resident ratio. And that’s only allowable in situations where you have the resources to do that. You know, 7 in 10 of our residents are on Medicaid, the state program for indigent elders. And the average cost for us to take care of somebody is $210 a day. We get paid $180 by Medicaid. It’s always been what they call a ‘cost minus payer.’ Now the problem that we’re having increasingly is we’re not getting the other payers to bail-out Medicaid. Federal health reform which just passed, includes some pretty major cuts to nursing home Medicare rates. Our private pay patients are disappearing; so the ability of these other two payers to carry Medicaid and give it the free ride that it’s had for 30 years – is disappearing, and it’s creating real problems for us.”

Rachel: “You know, we hear stories about families who are there, are in these facilities – and they can’t get help. And I’m wondering if the profession, the industry, has a way – a place – for people to go to get help when they see something is wrong with the care.”

Scott: “Yeah, we strongly encourage people to kind of move up the ladder. The first thing if you’re in that situation you should do, is talk to somebody in the facility that you’re comfortable with. Now that might be the social worker, it might be the director of nurses; it might be the administrator. But you take your complaint to the people who have responsibility for caring for your loved one. If that doesn’t get resolved, the next stage is the Ombudsman program.

Each nursing home has a volunteer Ombudsman who’s assigned to that home. The information is posted, is available to anybody. You take your complaint to the Ombudsman who is then legally responsible for investigating that complaint, and then trying to reach a resolution between you, the facility, and the Ombudsman. And it’s an informal, kind of non-legal step that you can take, and many complaints are resolved at that level. The next stage after that is if you can’t get any assistance, is you go to the Department of Public Health. You can lodge a complaint with the Department of Public Health, and that complaint has to be investigated by DPH. And DPH, if it finds that there’s legitimacy to the complaint, will cite the nursing home and get the complaint resolved.”

Rachel: “What does a family do if time is of the essence – in other words they can’t really wait – for all these agencies to get into gear? Do the nursing homes – do they have anything set up to respond?”

Scott: “The answer is, is the Ombudsman is in the nursing home – many of them every single day. So the Ombudsman is a steady presence there. So it isn’t as if you’ve taken it up with the nursing home, and then you wait a week or two, and they don’t resolve it, and then you go to the Ombudsman and it takes another month; then you file a complaint with DPH, and they’re – that’s not the cycle. The cycle is far more telescoped than that. So I think there is a hierarchical way to get the problem resolved.”

Rachel: “That was Scott Plumb – he’s the senior vice president of the Massachusetts Senior Care Association. I’m Rachel Gotbaum for Elder Law Radio.”

Narrator: “Thank you for listening to Elder Law Radio, a production of Elder Law Answers. Elder Law Radio, sponsored by Sokolove Law at www.SokoloveLaw.com. For more Elder Law Radio, go to ElderLawAnswers.com/Radio.”

For legal help, call (800) 581-6358.

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