Budget for home-health visits slated for decline; protests being organized

[NRSKarenRN, BSN, RN]

march 18th, 2002

by larry wheeler

gannett news service

washington-the good news for medicare beneficiaries: despite dramatic declines in the number of home health agencies nationwide, nurses and aides are still widely available to elderly patients who qualify to receive certain health care services at home.

the bad news: the government is preparing to cut home health payments 15 percent by oct. 1. industry officials and a number of lawmakers want the 15 percent reduction canceled, saying cuts have gone far enough.

dropped dramatically.

since 1997, medicare home health spending has fallen, and 1 million fewer patients now receive those services. among elderly medicare beneficiaries who qualify for home care, the average number of visits received from nurses and aides has

the reversal was precipitated by strict new payment rules designed to curb home health spending that had skyrocketed during the 1990s. simultaneously, justice department and government auditors aggressively began pursuing fraud and abuse in the home health sector.

hundreds of agencies closed, but no evidence is conclusive that medicare patients have suffered.

full story:

http://enquirer.com/editions/2002/03/18/loc_medicare_sector_up.html

despite dramatic declines in the number of home health agencies nationwide, nurses and aides are still widely available to elderly patients

that depends on what are of the country you live in. city homecare agencies are having a hard time obtaining cna staff----can get same pay at mc donalds or wallmart for less stress and responsibility. student nurses are working other jobs that pay more instead of being cna's while in nursing school has been my experience over the past 6 -7 years in philadelphia region. yet alone people who pass criminal background check, attend orientation or cna training are given an assignment and never show up for work...1 in 15 occurance in my experience. karen

[oramar]

I was wondering if anyone has tracked patients who lose home care coverage to see if they experience more hopital admission. This could be one of those penny wise pound foolish situations.

[hoolahan, ASN, RN]

Karen, I think the same thing about that quote. We had an open house for nurses, PT, and HHA's the other day....NO ONE SHOWED UP!!! Not one person for any position.

First of all, home health agencies in my area, cannot compete with the bonuses and salries and Baylor's etc being offered at the hospitals, and several people have left to go back to the hsopitals, they got bonuses, more money and Baylor option. We have lost about 4 nurses in the last 6 months, and no one has replaced them, yet we are accepting the same number of referrals. Our agency "pushed" 80, yes, EIGHTY visits, for pt's we were unable to fit in during the week. My agency never says no to referrals, and we are really feeling the squeeze. If they keep pushing the nurses like this, more will leave, the paperwork is already doing most of them in.

If there is a 15% decrease in the budget, I don't think homecare will even be an option, as many agencies will have to close. We barely break even on most of our cases, and lose on many. PPS does not really balance out the way it should.

[Huganurse]

oramar, I wish they would do that study. I think you are right! After I D/C'd many of my HHC patients, I followed what happened to them, although it was not scientific, my patients were admitted to the hospital more frequently~~ a few of them within 2 weeks of my D/Cing them. They no longer qualified for MCA HH visits so I had no choice. The ones I didn't call and keep track of I noticed popping up in the obits. So sad. I knew I was helping them stay home and at their optimal health thus avoiding hospitalization or worse!

There are so many cuts right now in fed and state budgets that decrease funding for health care it is outragious! I write to the senators and governers and it all seems to fall on deaf ears. The state reps say they have no choice due to federal cuts. The fed reps say they don't have the money due to thier budgets and that it is worse due to the war on terrorism. So where does all that money go? Don't get me started. I left HHC due to corp take overs, Hillarys cut backs, PPS and HMO's, I knew it was only the beginning of a failing system for HHC and I am glad that I did leave especially now that I know it is worse than ever.

[Mijourney]

Ho hum. The consequences of the Balanced Budget Act of 1997 left my mouth gaping. I am really considering calling it quits in this chapter of my career. I don't know how we are expected to help those receiving Medicare and Medicaid with deeper payment cuts. I'm have trouble holding on to doctors for some of my patients because of the payment cutbacks to their practices.

I am in pain for my elderly patients. A good many of them don't have the family support they need to get through these cutbacks. From time to time, I try to do what I can out of my own resources but that's obviously not sufficient, and I can't afford to sustain it. Many of the doctors will provide me with samples for medication when they have it that can't be gotten otherwise. How many rabbits are we home care nurses supposed to pull out of a hat?