Home health troubles

When Congress cut Medicare reimbursements to home-health agencies two years ago it was warned that the result would be worse care initially and then the demand for more acute care that, ultimately, would cost even more. Considering what has happened since then, the home-care Cassandras of ’97 now look like cheerleaders.

The situation is worse than most people predicted because it is joined with a shortage of workers in long-term care facilities. That means home-care agencies are hard-pressed to deliver good service to the elderly and nursing homes are struggling to take care of the patients they have. In the last few years, the number and severity of deficiencies reported to the Division of Licensing has almost doubled, according to Christine Gianopoulos, director of the Bureau of Elder and Adult Services.

Ms. Gianopoulos was responding to legislators on the Health and Human Services Committee, which is trying to prepare for the growing number of elderly residents who will need services. The committee’s preparation is an excellent idea. Unfortunately, many of the problems stem from cost-cutting on the federal level and may not be solved until congressional shortsightedness is overcome.

While Congress remains visibly fearful of any major overhaul of the nation’s piecemeal health-care system, it has tried to reduce costs in simplistic ways, notably by freezing or cutting reimbursement rates for health services. The results were heard this week at the committee hearing. Elderly care in Maine is a train wreck waiting to happen, said Ms. Gianopoulos. Some might argue that it is happening, in slow motion.

Nursing homes cannot afford to pay enough to attract a sufficient number of workers to meet demand; home-care agencies have reduced visits by 25 percent because of budget cuts. Just a couple of years after Maine made the sensible policy decision to emphasize care at home for both the patient’s piece of mind and cost-savings that allowed agencies to serve more people, the system is overstressed for reasons that could be solved through congressional action.

Sen. Susan Collins has introduced the Medicare Home Heath Equity Act, which would stop another scheduled rollback of home-health reimbursements and would provide payments to agencies based on actual patient costs and not by assumed averages. A new, more promising payment system has been in the works for a couple of years, but the proposal by Sen. Collins makes needed repairs to an interim system that is driving agencies bankrupt in Maine.

Real improvements to the Medicare payment system won’t occur until Congress gets serious about reforming health care. Until then, the least it can do is listen to providers and take steps to prevent health-care agencies from being driven out of business.