Each day up to 300 elderly residents of the District of Columbia occupy hospital beds needlessly because nursing home beds are not available, according to a study by the National Capital Medical Foundation.
In addition, about 400 low-income residents of the District who need nursing home care, but must rely on Medicaid to pay for it, are waiting for beds. This translates into a waiting period of two years, said Pat Yates, acting chief of social services for the Department of Human Resources.
"The situation is desperate," said Geraldine Brittain, in discussing the critical shortage of nursing home beds. Brittain is supervisor of social services at Columbia Senior Center, a city-funded activity center for the elderly.
"We have people who simply cannot live alone," she continued. "One woman can't navigate to the toilet anymore. We send a homemaker to her four hours a day, but she's alone the rest of the time. Another woman is bedridden. We send a homemaker in the morning to get her out of bed and someone else in the evening to put her back in bed; we're working on weekend service. These people need 24-hour, supervised care, but it will be months before they can be placed in a nursing home-if they don't die before hand."
Care in District nursing homes is costly, averaging $35 a day. While Medicaid would pay for a nursing home bed, finding one is almost impossible.
Persons who can afford the rates, which range from $23 to $82.50 daily, fare only slightly better. Occupancy rates run between 96 and 98 percent.
The shortage of beds that existed two years ago when the District Weekly last surveyed nursing homes has become worse and remains a serious problem for the elderly who need nursing home care.
Nursing home fees have increased 8 percent in the last two years. District Medicaid recently changed its method of reimbursement from a flat rate of $15 to $20 a day per patient to a reasonable-cost system under which reimbursement averages from $35 to $40 a day per patient, but even this has failed to ease the desperate shortage of Medicaid beds.
To qualify for Medicaid coverage of nursing home care, a District resident must be over 65 and indigent. Net income cannot exceed the fees charged by the nursing home and liquid assets cannot exceed $2,500. A physician must also complete a form on medical eligibility. If a Medicaid applicant is not placed within 30 days, an updated physician's form must be resubmitted.
Many city residents who can pay their own way seek care in suburban Maryland or Northern Virginia nursing homes.
Medicaid patients are far more restricted because they can use only a nursing home certified for and under contract with District Medicaid. In addition to the certified homes in the District, three suburban Maryland nursing homes have contracts with the D.C. Medicaid office so that they can accept eligible residents.
City social workers do what they can for the approximately 400 low-income citizens who are waiting for Medicaid-financed beds, according to Yates.
"All we can do is provide home-maker, chore or meals-on-wheels service for these people," she said. "Our first emphasis has always been on keeping the individual in the community, but many of these people need care around the clock. It is not safe for them to be alone at night, but there is no place for them to go."
In addition to about 300 elderly persons needlessly hospitalized because no nursing home beds are available, St.Elizabeths Hospital, a federally funded mental institution, has about 150 resients who need less institutionalized care and could be cared for in a nursing home, according to Jim Buford, project manager of the St. Elizabeths Initiative Program at the Department of Health, Education and Welfare.
The District has 1,887 nursing home beds in 10 licensed nursing homes, or about 40 beds per 1,000 elderly residents; the national average is about 52 beds per 1,000 aged. Only 971 beds are certified to accept Medicaid patients, and the nursing homes and need not-and do not-fill all their certified beds with Medicaid patients.
"We thought that when Medicaid payments increased more beds would open up for Medicaid patients, but it hasn't worked out that way," Yates said. "It's a seller's market and nursing homes prefer private-pay patients because they still pay more than Medicaid."
Recent losses of beds have made a bad situation worse. Little Sisters of the Poor closed its 133-bed facility at 220 H St. NW in 1977 to make room for a highway. In June, the Sisters bought St. Joseph's Priory near Catholic University, which they plan to convert to a home, but they are still doing paperwork that must be completed before they can start work.
The National Lutheran Home for the Aged will move to Rockville by the end of the years, which means a loss of 300 beds.
D.C. Village, the city's public nursing home, which is available to anyone in need of institutionalized care, uses only 539 of its 700 beds because of lack of funds. The 1980 City Council budget calls for funding 100 more beds in the facility. Meanwhile, the waiting time for entry into D.C. Village is three years.
State health planners have issued certificates of need for 1,600 more beds and have signed letters of intent for 400 beds. It is unlikely that all will come into existence. Some of the certificates of need have been issued year after year, without the applicants ever constructing facilities. A letter of intent means that an applicant has expressed an interest in applying for a certificate of need.
Of the 1,600 beds, 250 are part of the J.B. Johnson facility, which was privately built about five years ago by a group of doctors. The Johnson home never opened because it did not meet licensing and certification requirements. The doctors defaulted on their federally guaranteed loan, and HEW eventually fell heir to the facility. HEW is now renovating the property to meet federal certification requirements. Once completed, the facility will be turned over to the District government. The target date for opening is next November.
Jim Buford, project manager of the St. Elizabeths Hospital Initiative Program at HEW, the office that is overseeing renovation of the Johnson home, said that about 150 of the beds would be used for patients at St. Elizabeths who are waiting for nursing home placement. Another 100 will probably be slated for patients now in District hospitals.
There also is community pressure to convert beds at D.C. General Hospital from acute to long term care. The D.C. General Hospital Commission, an independent, citizens' oversight commission established in October 1977 by the City Council, has discussed the possibility.
Mae Phillips, community reresentative on the commission's task force for long term care, said, "We've been promised long term care beds so long and nothing's been done. Why can't we take a few of the empty beds at D.C. General, eliminate them from operation of the hospital and use them as nursing home beds?"
The task force is also exploring an alternative proposal to build a seperate facility on the grounds of D.C. General, said Natalie Spingarn, chairman of the Planning and Development Committee of the commission.
Consumer advocates had hoped that the Lutheran home would be bought by a group willing to continue running it as a nursing home.
"The people at the Lutheran home made a moral commitment to sell to someone who would care for the elderly, and a lot of people were interested but they turned out to have big hearts and small pocketbooks," said Karyn Barquin, nursing home ombudsman for the city Office on Aging.
"We are hoping that this facility could be used for the needs the District has for nursing home beds," said Melba Reichard, an administrator of the Lutheran home. "But it all depends on who comes along and can afford to but it." The facility is priced at more than $4 million.
The Office on Aging is putting together a proposal to buy the facility and turn it into a geriatric center that would be run by the Office on Aging, Barquin noted.
"We would maintain some of the beds for long-term care, but we would also offer residential and personal care, day care, respite care and an assessment center," Barquin said.
Next week: A report on the quality of care in nursing homes. CAPTION: Picture 1, Sonia Michaelson, a resident of the Washington Home, tries a little indoor gardening. Photos by Craig Herndon-The Washington Post; Picture 2, Mary Bowes, a resident of the Washington Home, discusses care of a plant with Denise Sprague, an occupational therapy assistant.