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OH Budget Deal that Cut Nursing Home Care Standards Still a Key Issue

The Plain Dealer

Lisa DeJong, The Plain Dealer


By John Caniglia and Jo Ellen Corrigan

In the contentious 2011 budget, Ohio’s lawmakers negotiated a little-known concession with one of the most powerful statehouse forces, the nursing home lobby.

The results of that deal play out daily in nursing homes across the state.

In his budget proposal, Gov. John Kasich sought to cut Medicaid dollars to the state’s care centers and funnel much of the savings to home and community services, a move that would allow residents greater choices in where they wanted to live.

Legislators, in support of nursing homes, countered. To balance the drop in Medicaid reimbursement dollars, they reduced the amount of time nurses and aides are required to care for residents each day, an unprecedented move that still angers researchers and advocates for nursing home residents.

This week, the state legislature enters the final days of another budget fight, one that could affect the way care is handled for tens of thousands of elderly nursing home residents.

Kasich’s administration has sparred with the nursing home lobby for months, questioning the care at Ohio’s low-performing facilities and pushing for managed-care plans for all nursing home residents. Currently, about 86 percent of Ohioans on Medicaid are part of managed-care plans.

Nursing homes bill Medicaid directly for tens of thousands of residents, according to interviews and published reports. By advocating for managed-care plans for those who need nursing assistance, Kasich said the state would save millions of dollars a month.

Managed-care plans are run by insurance companies that contract with the Ohio Department of Medicaid to coordinate the health plans of low-income residents, according to state reports. The plans work with doctors, hospitals, nursing homes and other providers to streamline services and reduce mounting costs, the reports said.

The nursing home lobby opposes managed care, saying the plans do not save money but instead add an inefficient layer of bureaucracy. The legislature, which has been known to side with the lobby, has stripped Kasich’s plan from the budget, but he remains optimistic that it can be resurrected.

Advocates for nursing home residents say managed care is not the most important issue.

“Until Ohio increases the minimum staffing standard, nursing home operators will continue to laugh in the face of regulators,” said Brian Lee, who leads a Texas-based national advocacy group called Families for Better Care.


“The minimum staffing standards
aren’t good enough”


“Over the past 18 years, I have been in many nursing homes in many states, and whenever I’ve asked about staffing levels, they’ve all sung the same song: ‘We’re meeting the minimum standards.’ Well, the minimum standards aren’t good enough.”

In recent weeks, Kasich’s administration cited the state’s low-performing nursing homes, which are among the worst in the country in terms of care, in its push for managed-care plans. In the months-long series, “A Critical Choice,” The Plain Dealer found that four of 10 nursing homes in the state provide care that the federal government considers substandard.

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