THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Saturday, August 24, 1996 TAG: 9608260317
SECTION: FRONT PAGE: A12 EDITION: FINAL
TYPE: Editorial
LENGTH: 61 lines
Manning Convalescent Home in Portsmouth is on the brink of being declared ineligible for Medicaid funding. It has allegedly failed to comply with standards for the federal/state program.
Since Medicaid pays for 95 percent of Manning residents, being cut off would cut Manning patients adrift. Its fate is their paramount concern, but for the rest of us this case raises a larger issue - the fate of Medicaid itself.
As life spans extend and baby boomers age, millions will find themselves in convalescent-care facilities and nursing homes that can be shamefully mismanaged. The residents can no longer care for themselves and are often bedridden. Many have no close relatives to monitor their care and even if maltreated or malnourished have no voice to protest or ability to seek other accommodations. Medicaid now covers 68 percent of nursing-home residents and 50 percent of nursing-home costs.
The failings alleged against Manning don't begin to catalog the possible dangers to patients, but they hint at the scope of the problem. An unsupervised patient crawling out of the building in freezing weather. A patient experiencing breathing difficulty due to an incorrectly cleaned feeding tube. Potentially life-threatening delays and errors in providing food, care and surgery.
Because the patients in these facilities are out of sight, it's easy for society to put them out of mind. But they could be our parents or, eventually, ourselves. Because their care is paid for with our tax dollars, the quality of their care is arguably our responsibility. At present, 69 percent of Medicaid money goes to care for 10 million elderly and disabled Americans.
Oversight is not perfect, but the Manning case suggests that some successes can be counted in monitoring these facilities. A year ago, the federal government imposed a tougher inspection process on nursing homes that consistently had problems meeting expectations. In cases deemed alarming, noncomplying providers of care can be fined or declared ineligible for Medicaid.
Critics argue that should happen a lot more often. The nation, however, is in the midst of an entitlement debate that could lead in the other direction. It is a conservative article of faith that a distant, bureaucratic, profligate federal government can't manage programs like Medicaid as well as the individual states.
That may or may not be true, but there certainly may be other more-efficient models for providing medical and nursing-home care for the poor, the elderly and the infirm. But devolving such programs to the states through block grants or other means entails risks. Can states be counted on to assume responsibility for setting standards and monitoring compliance?
Before we leap into reform, this society must look very carefully at possible consequences. This isn't an abstract argument about states rights or entitlement reform. It's about the real lives of patients in real places like the Manning Convalescent Home with their feeding tubes, surgical staples and gangrene.
Too often the discussion asks: How much money will we save, how much will taxes go down? Good questions. But any proposed reform must answer another question as well: Who will look out for these patients, set standards and make sure they are being met?
KEYWORDS: NURSING HOMES by CNB