Louisiana Nursing Home Industry Critical of Breaux’s Call to Move Elderly To Home-Based Care

Following a U.S. Senate Select Committee on Aging hearing in which Sen. John Breaux (D-La.) criticized the Louisiana nursing home industry and state officials for not providing long term care for the elderly in their homes instead of nursing facilities, the Louisiana Nursing Home Association, has released a three-page memorandum disputing the senator's assertions, the Baton Rouge Advocate reports. While Breaux's hearing focused on Medicaid reimbursements and long term care on a national level, his comments have spurred debate in Louisiana over Medicaid funding and policy regarding home-based elder care. Currently, Louisiana provides subsidized care for about 700 seniors at home or "non-nursing settings" through a Medicaid waiver program. According to the figures from the state Legislative Fiscal Office, Louisiana spends an average of $21,609 for a senior in the Medicaid waiver program, compared to an average of $14,051 for seniors in nursing homes. Based on these figures, the LNHA said that Breaux's "push" to shift seniors to home-based care would only shift Medicaid funds "without providing" additional resources. In addition, the LNHA stated that if the state were to begin subsidizing home-based services, low-income seniors who are not enrolled in Medicaid would "sign up for the new at-home services." The resulting Medicaid caseload expansion, or more seniors using the "same pot of Medicaid funds," would lead to cuts in either health care services for nursing home residents or reimbursements to homes, according to the LNHA. While recognizing that some "less-frail seniors" do not require nursing home care, the LNHA said the entire approach to long term care needs "reworking," instead of simply shifting "existing Medicaid funds." Lisa Gardner, public relations director for the LNHA, said "gaps" in Medicaid and Medicare are the "overriding issue," as both programs "fail" to "properly cover" long term care for seniors. "[W]e need to look at more than just how we stretch a Medicaid dollar," she added.

Breaux, State Officials Disagree
Breaux and state Department of Health and Hospitals Secretary David Hood, who spoke at the aging committee hearing, "sharply disputed" the LNHA's findings and figures, the Advocate reports. Hood said the LNHA "is comparing apples and oranges" by citing the spending figures from the state Legislative Fiscal Office. Specifically, he said the LNHA "confused" elder care costs by calculating the figures using both the Medicaid waiver home care expenses for the elderly and a separate waiver for providing home care to non-elderly low-income individuals. In reality, Hood said caring for an elderly patient at home costs Medicaid $9,509 per beneficiary per year, compared to $14,000 annually per nursing home resident. Moreover, Hood noted that the federal government mandates as a requirement of the Medicaid waiver that home-based care be less expensive than nursing home care. "So [Medicaid beneficiaries] can't cost more (at home). If they did, the feds would cancel the waiver," Hood said. Breaux added, "Everyone who has ever testified -- Secretary Hood ... [HHS Secretary Tommy] Thompson -- has said that alternatives to nursing homes are, in many cases preferable. Not only are seniors happier, it's actually cheaper ... everybody is in agreement, except the nursing home industry" (McKinney, Baton Rouge Advocate, 7/30). For further information on state health policy in Louisiana, visit State Health Facts Online.