- The Washington Times - Friday, November 9, 2001

Several weeks ago, I found myself crying uncontrollably in public. Tears, from someone who is usually viewed as a strong, self-assured woman, are a rare sight even for those closest to me.
I had gone for my daily trek to the nursing home to check on my mother, who had fallen yet again. She had reinjured her previously broken hip and suffered other minor scrapes and bruises because she could not remember that she could not walk.
I entered her room to find a nurse dressing her eye, which was so bruised, bloodied and swollen it looked as though she might very well lose it. She didn't, but I did.
Through my frustration and fear, I screamed at the shocked staffers that I planned to pack my mother's things immediately and take her home. It wasn't so much that the staffers were incompetent or uncaring; it was that there were simply not enough of them to adequately attend to the large number of patients.
I had absolutely no clue how I could manage my mother's care with the multitude of medical problems she's enduring. I've unsuccessfully tried that herculean feat. Her full-time care was much more complicated and comprehensive than my family and I were equipped to master.
After I was calmed down by the comments and reports of about a half a dozen staffers from the nurse practitioner to the social worker to the physical therapist, it became clear that my mother was still too sick to come home.
Today, however, I am able to tell a much different story. She is on the mend again, thanks in no small part to visits of at least one family member nearly every day that allow us to diligently monitor her progress and her care.
Having spent so much time in a nursing home lately, I've witnessed enough to know that the patients who get the best care inside are the ones who get the best care from outside.
Once the staff learned what I do for a living, they couldn't tell me enough about the bureaucratic maze they must maneuver to justify financial reimbursement from insurance providers, especially from government-funded Medicaid and Medicare. They are reimbursed for from 2.1 to 2.7 hours of care per patient per day. But those dollars do not have to be spent on direct patient care. They can be spent on marketing, administration, supplies or furniture.
Are you aware that nursing-home patients who are unable to bathe themselves are entitled to only two showers a week? That some registered nurses do nothing all day but fill out paperwork, never once touching a patient?
The facilities private as well as public are understaffed, they have high turnover rates, and many of their workers, skilled and unskilled, leave as soon they can find a position elsewhere with a little higher pay and a little lower patient loads.
"The system's failure lies in its unfair reimbursement for senior care. Medicare and Medicaid pay good and bad providers equally," said Dr. Gary Applebaum, senior vice president and medical director of Erickson Retirement Communities in Maryland and Virginia.
Dr. Applebaum likens caring for an elderly 80-pound patient with multiple needs to caring for a newborn 8-pound infant. They both need constant care. It's true what they say, that most of us will leave this world the way we entered it needing someone to feed, clothe and clean us.
"This is hard, hard work and there are never enough resources to take any off the table," Dr. Applebaum said yesterday. "No [amount of federal funds] can pay to have one-on-one care for everyone."
So you can imagine my outrage when I read that Virginia Gov. James S. Gilmore III intends to use a mind-boggling budget gimmick to divert much-needed federal Medicaid dollars into the state's general fund to offset unexpected revenue shortages.
For shame. After all, the Old Dominion has an abysmal standing among states for Medicaid and Medicare reimbursement rates as it is, ranking 44th in the nation.
Virginia and Wisconsin from whence hails Secretary of Health and Human Services Tommy G. Thompson were the last two states allowed to take advantage of a legal loophole that has allowed 30 states to borrow against Medicaid dollars to boost their budgets for other uses.
Mr. Gilmore has until Nov. 15 to shuffle enough forms to apply for the funds meant for Medicaid recipients as long as he gets help from localities willing to go along with the disingenuous practice. Congress, uncomfortable with the tricky transactions, voted to discontinue it.
Mr. Gilmore's gimmick might be legal, but it's tantamount to stealing from the elderly, who unquestionably need more dollars for better care. Don't believe me? Listen to government officials who say the phony ploy is "unethical," "an outrage," even "a scam."
Fairfax County Executive Anthony H. Griffin, who called the scheme inappropriate because it is not certain whether the Medicaid dollars will be used for their intended purpose, told The Washington Post: "Where we could use Medicaid help from Virginia, we're not getting it."
Virginia Secretary of Health and Human Resources Louis F. Rossiter told The Washington Times that the federal government permits this usage and "Virginians pay significant sums of money to the federal government in taxes, and they deserve the benefit of these additional funds."
Yes, indeed, they do. And, Mr. Gilmore should do the right thing: Get every penny of the estimated $259 million in matching Medicaid funds that the state is entitled to and earmark that money exclusively for patients eligible for those funds.


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