Health Care In Need Of Life Support

Abu Ghraib?

In Virginia, we call it assisted living.

That would be one conclusion to be drawn from descriptions in The Post's May 23-26 front-page series on conditions in Virginia's more than 600 assisted-living facilities.

For veteran Virginia readers of The Post -- particularly those in the outer reaches -- such reportage bears a familiar tilt toward anthropology, as in "go down there and discover what new horrors those people have manufactured." Sadly, The Post's journeys of this sort -- into prisons, mental hospitals, struggling rural communities, etc. -- invariably prove fruitful.

Hand-wringing follows, along with official finger-pointing in the direction of states farther south, accompanied by pleadings to the effect, "Yes, but they're worse." Actually, when it comes to "interventions" -- into welfare, health care, anything care -- Virginia is its own Mississippi. Even during the Depression, while Virginians loved FDR, they remained loyal to state pols who embraced a basic operating philosophy: "You're on your own, bub."

True to form, when it concerns the long-term care of Virginia's growing legions of elderly citizens, the formula remains simple: You get what you pay for.

The environs of gentle Williamsburg, for instance, have become something of a haven for retirees, with gated communities providing various levels of independent living, assisted living and nursing care. It's all well-tended and comfortable. Just come with lots of cash.

For those not so well furnished, there's the state-administered Medicaid program and the strictest medical eligibility criteria in the nation. One foot in the grave and the other on a banana peel seems to be the threshold for getting financial support in Virginia.

Qualify -- and you also have to be poor or fully divested -- and you get to live in a nursing home. Otherwise, it's assisted living and, potentially, a dreary space next to a "deinstitutionalized" mental patient.

That's bad enough, but conditions in many Virginia nursing homes are likewise less than ideal. "Dozens of nursing homes throughout the [eastern Virginia] region," the Norfolk Virginian-Pilot reported last year, "have incurred stacks of safety and health-care violations. . . . A legislative study in 2000 found that more than half of Virginia's 275 nursing homes failed to meet federal quality standards."

And, because Virginia so severely restricts Medicaid coverage, the state has the sickest nursing home population in the country. "That means nursing homes in Virginia must meet the greatest demand for services in the nation with one of the smallest pots of government money," the Pilot reported.

Unquestionably, Medicaid demands a lot of revenue. In 1980 the program cost Virginia $382 million; in the fiscal 2006 budget, costs exceed $4.4 billion.

Still, the problems are obvious and acute, and they go beyond care of the elderly. For example, a desperate Shenandoah Valley hospital administrator recently met with state legislators to tell them that stagnant Medicaid reimbursement rates and rising liability insurance premiums are forcing obstetricians out of the state. The central valley could be left with five or even fewer obstetricians to deliver 1,900 babies annually -- 30 percent supported by Medicaid. It can't be done.

Yet when Republican legislative leaders gathered for a conference on Medicaid and the rising costs of long-term care in September, the preferred response was an insurance tax credit. That's dandy, but it hardly addresses conditions in nursing homes and assisted-living facilities.

Instead, House Speaker William J. Howell (R-Stafford) said, "Looking ahead, the addition of more aged and disabled persons requiring care and escalating health care costs will outpace our ability to provide adequate resources for these vulnerable citizens."

Outpace our ability? It's more like outpace Virginia's willingness.

Gov. Mark R. Warner says that "this issue is not going to go away," and he's right about that. The number of Virginians age 85 and older is expected to rise by more than 135,000 between now and 2030.

What Virginia can do -- and must do immediately -- is a far better job of regulatory oversight and dissemination of information. The governor says he has folks working on it. We'll see.

Ultimately, Virginia will have to determine what moral claim the vulnerable and elderly can make on the income-producing population. How it answers that question will speak loudly about the character of the commonwealth.

Or, to put it another way, last year we apologized for sterilizing mentally defective people a century ago. This year, we apologized for "massive resistance" to racial desegregation a half-century ago. It might rank as progress if Virginia could do things now to avoid an apology years hence for its abuse of the elderly and infirm.

gcmorse@cox.net