Dan Haar: Patients Stuck In Hospital Beds Due To Medicaid Home-Care Cut

The call from Connecticut Children’s Medical Center on Monday was supposed to be routine.

A case manager at the hospital in Hartford had a 14-year-old patient ready to go home. She needed to make sure the preferred home health agency, Pediatric Services of America, had nurses ready to visit the youth’s home.

Medicaid covers the cost of the home visits. But it’s been 10 years since agencies such as PSA have seen an increase in those basic rates — $37 an hour for a licensed practical nurse, $45 for a registered nurse.

A small add-on fee, less than $2 an hour, also covered by Medicaid, was tacked on a few years ago for some of the most severe cases. But, starting Aug. 11, with no state budget adopted, Gov. Dannel P. Malloy ended those add-on payments in an executive order — to save the state $1.9 million a year.

“These ‘add-ons’ are not an absolutely critical factor. They are a way to provide extra compensation to providers who apply for them,” David Dearborn, the department spokesman, said in an email. Agencies traditionally have stayed afloat without the add-ons, he said. “They enhance a provider’s capacity, but they don’t necessarily make or break a provider’s ability to serve clients.”

Dearborn added that the state “is in the beginning stages of looking at alternative ways to modify payments for special complex care services.”

That needs to happen stat. We’ve been watching this crisis grow since the 2001-02 recession, when payments to the agencies flattened out. Now it’s 2017. The problem is not a threat — it’s happening now. The agencies can’t find nurses at the pay they’re offering.

These are not generic home care workers who watch clients and help with housework. In East Hartford, where Ariella Botts has a condition known as nemaline myopathy, the quality of the nurses has been inconsistent, Rachel Botts said, because the pay has not kept up — though she’s very happy with the current group of nurses.

“They need to be really able to see the subtle changes in her breathing to be able to know if she’s going to have a significant respiratory event,” she said. If the system collapses because of budget cuts, she said bluntly, “children are going to die because they will not get the care they need.”

With the add-on payments, Pediatric Services of America pays LPN’s $23 to $26 an hour and RN’s $27 to $30 — with no benefits. The flexibility is good and the nurses get a lot of overtime, which can be good for them, but it drives up the cost. The RNs can make much more in hospitals, and the ranks of LPNs are dwindling in Connecticut.

Also dwindling is the menu of options for the hospitals. “We may know in the next two weeks if any of the home care agencies are going to make a decision on whether they can continue to provide skilled nursing services to Medicaid pediatric patients,” said Sherry Greifzu, nursing director of ambulatory services. If it goes the wrong way, she said, “it will be an emergency.”

Here’s yet another reason for lawmakers to pass a damn budget and vote up or down on services like this one. Besides extended-hours nursing, the add-on covers services such as care for AIDS patients and security to escort nurses to patients’ homes in high-risk areas.

The situation is already an emergency, as Deborah Hoyt sees it. She’s CEO of the Connecticut Association for Healthcare at Home, which represents 65 of the agencies. The state is saving $103 million a year on care for Medicaid clients who are not in institutions, she said. “That’s great but all those savings are on the backs of the home health agencies, who haven’t had a raise in 10 years.”

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