A recent cutback in Virginia's Medicaid program has disrupted the lives of nursing-home patients, forcing some to move out of their beds and into new facilities, according to a survey released by a health advocacy group.
The state's new policy -- which no longer pays nursing homes to hold open patients' beds when they enter the hospital -- has contributed to frustration, grief, and in a few cases, even death for the elderly poor, the group charged.
"People are being traumatized by this change," said Karen Reisinger, spokesman for the Virginia Organization of Health Care Social Workers. "How many people must be affected before this policy is changed?"
The survey was challenged by the state's top Medicaid official, Bruce Kozlowski, who accused the group of "extensive emotionalism." The state's own figures, he said, show that almost all hospitalized nursing-home patients are eventually able to return to the same home. "It's not as if they're being bumped on the street," he said.
The survey's release this week comes at a time of renewed debate among advocacy groups and the medical community over the state's Medicaid program. The state Board of Health, attempting to close a $122 million deficit in the program, approved last June a sweeping series of cutbacks that some said had the effect of reducing many medical services to the poor.
There are new concerns that the state may make even more dangerous cuts in light of the projected $305 million state budget gap disclosed by Gov. Charles S. Robb last week. The prospect of such cuts "has put a lot of nursing home residents at risk," said Peter Clendening, executive director for the Virginia Health Care Association.
The new state policy regarding nursing home "hold days" has proved among the most controversial of the Medicaid cutbacks, potentially affecting all of the state's 21,000 nursing-home residents. The state used to reimburse nursing-home operators for 15 days to keep empty the beds of its residents who became hospitalized.
Starting July 1, the state ceased such payments, a cost-saving measure that is expected to trim $3 million from the Medicaid budget during the next two years. In an effort to minimize the impact on the elderly, state regulations require nursing homes to offer hospitalized residents "the next available bed" upon their return to the home.
The social workers' survey of 517 Virginia nursing-home residents who were hospitalized between July and September said that 58 did not return to the same homes. In 30 of the cases, no bed was available in their former nursing homes. Five of those 30 patients died after release from the hospital, the survey found.
Reisinger noted that medical research has established that moving the elderly "increases their chances for disorientation, illness and death." The full impact, though, is far more extensive, she said. In some cases, families are struggling to reimburse the nursing homes on their own. In others, nursing-home patients are refusing to enter the hospital because, she said, "they live with the fear of losing their beds."
Kozlowski said that the state's own survey showed the impact of the new policy was minimal, with only 4 out of 567 hospitalized patients being denied reentry to their old nursing homes. He attributed the discrepancy in the two surveys to the fact that some patients, while initially denied reentry, later were returned to their prior homes once a bed did become available.
"The new policy is working and it's working well," Kozlowski said.