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Nursing Homes Face Reductions In Services

By Chris L. Jenkins
Washington Post Staff Writer
Sunday, February 8, 2009

One in a series of reports exploring the impact of budget cuts being contemplated by elected officials in Maryland and Virginia.

Inside the Heritage Hall nursing home in Leesburg, mid-morning light streams into a first-floor dining hall. Many of the dozen or so seniors who chat and nap have stayed after breakfast to enjoy each other's company.

Instead of having meals brought to their rooms on carts, the residents walk or wheel themselves in line and select from steak fingers or chicken, an assortment of vegetables and two desserts, dished up by staff members.

The full-service dining hall may seem like a standard service for a nursing home. But in this year of budget cuts, this service is a luxury that might not last. Heritage Home pays an extra $1.50 per resident, per day -- $600,000 a year -- to allow them to choose their meals.

As part of his budget proposal to fill a $3 billion budget gap, Virginia Gov. Timothy M. Kaine (D) has proposed cutting $400 million from the state's Medicaid program. In Maryland, state budget writers have frozen a planned $96 million increase in Medicaid funds to community organizations that would cover the rising costs of services, according to the Maryland Budget and Tax Policy Institute.

The federal-state health-care program for the poor and disabled pays for about 60 percent of the residents at Heritage Hall. Because often a high fraction of nursing-home residents are Medicaid patients, nursing homes usually are hit hardest when state governments cut back funding.

"There is quality of care, and there's quality of life," said Ted LeNeave, president and chief executive of American HealthCare, which owns the 16-facility chain. Quality of care, he explains, are the basics: food, shelter, medical treatment. "Not one nursing home will ever cut down on these services," he said.

But quality of life are the things that make life fun -- a field trip, entertainment, a fully stocked library, Get Your Hair Done Day. "It's more than just bingo," he said.

Under Kaine's proposal, the 164-bed nursing home would take a $2.5 million hit. Already, LeNeave has let four people at the Roanoke headquarters go. He knows nickel-and-dime cuts won't close the gap. In times like these, LeNeave said he tries to look for more private-pay customers to make up for the increasing cuts in Medicaid. But there are only so many he can recruit.

His plans now involve cutting $500,000 of the $2.5 million from his staff health-care plans. That means his employees could see between $700 and $1,000 increases in their premiums annually.

"All of these are to avoid having the residents feel anything," he said.

After that, he said, quality-of-life activities are on the block. Chances are it won't be hair day. "That would cause a riot," LeNeave said. As LeNeave speaks, a woman in a purple smock is getting her new hairdo touched up. The hairdresser fluffs it up with a comb and blow dryer. The hairdresser holds up a mirror. In the reflection, a smile.

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