Patti Cullen's Blog

How can we get people to care about funding for senior services?

by Patti on Tuesday, February 28, 2012 12:14 PM

Insanity: doing the same thing over and over again and expecting different results.
- Albert Einstein

As I have begun the editorial board “swings” for this session, at the end of our meetings,  I feel like I am saying the same things I have been saying for the past few years, but expecting different results. 

The story I am telling is all too familiar:

  • Our profession is noble, but the continuing reductions are impacting the services we can provide; and are further limiting choices for seniors without means;

  • As the recession improves, our workforce erodes — we can’t expect our nursing staff to work for us for $30,000 a year less than they could make at a neighboring hospital;

  • 62 nursing facilities have closed in the last dozen years, with a few more planning closures within the next six months — at a time when the demographics would indicate the need for more beds;

  • Proposed changes to level of care eligibility will likely force additional closures as the changes have a disproportionate impact on facilities, with some experiencing significant occupancy losses;

  • The demand for primary caregivers — nursing assistants — will increase by 65% by 2030 yet with the four years of frozen rates, the hourly rates we pay them have actually decreased if adjusted to 2011 actual dollars;

  • The shortfall per Medicaid patient day for nursing facilities in Minnesota continues to grow — the gap between rates we are paid and costs incurred is over $28 per patient day;

  • The Medicare rates, which have for so long kept doors open as they have been used to supplement the underfunded Medicaid rates, have been reduced as well — over 11% reduction on October 1, 2011; and

  • The 15% cumulative cuts to the elderly waiver program during the past two years have taken their toll on access to these services for seniors without means.

At the end of the numerical recitation, the question often is: Now what?? Or how can we get people to care? Both are valid questions. It doesn’t look like this years’ legislative session will be very relevant — very few bills will actually pass and get signed into law. While key legislators appear empathetic to our concerns, there will be no new money, and the reductions in all sorts of programs over the past few years means there is no “borrowing” for other parts of the budget. This holds true for both state and federal activity — where budget balancing is the mantra and doing it without new revenues is the expectation. It may be difficult for us to get the current legislature to care enough to address the crisis we are facing, but now that the redistricting maps are out, we have an upcoming opportunity to shape our future.

The next months will be saturated with political rhetoric, so I think we need to be prepared with strong expectations of the candidates worthy of our votes, and be sure that we share those expectations beyond our inner circles. The results of the poll we did late last year told us that we have more support than is evident by legislative action. In the poll, Minnesotans stated that they believe access to quality senior care is a right, not a privilege; and they are willing to pay more in taxes to improve long-term care services. We all have an obligation to make sure the candidates running for office have full knowledge of our issues, our current financial stress, and what another year of inaction will mean to the services we are expected to provide. We need to show that we are sane in our expectations — expectations such as:

  • regular inflationary rate increases that can be used for caregiver wages and benefits;

  • funding for those unfunded mandates such as new elevators and health information technology expectations;

  • new demonstrations that truly integrate acute care and long-term care services and supports;

  • people who can afford it will pay for their long-term care, and should pay what it actually costs; and

  • people who have no means should still be able to have access to the “right” level of services — meaning that home and community based service rates need to be adequate to pay for what consumers need.


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