There is no point in looking back at what should have happened because this will not solve the current problems of the long-term care facility. A task force has been established, made up of elected officials, the retired hospital CEO, hospital board members, health care district board members, and others, to figure out a way to improve the situation. What is unfortunate is that there is no one on this task force who has any expertise in long-term care. The “My View” article explains a few options that have been considered, but it seems that the biggest push is to implement a rural hospital sales tax.
There is another solution that has not been mentioned except by those in the long-term care industry. It is curious that this solution is being ignored. The solution involves changing the license of the care center to include Medicare reimbursement. Currently, it is only licensed to accept Medicaid. Anyone involved in long-term care management will tell you that in order for a nursing home to be financially viable it must receive Medicare reimbursement.
This is not intended to be a tutorial on Medicare and Medicaid reimbursement. The bottom line is there is a higher reimbursement for the federally funded Medicare program providing short-term skilled nursing and rehabilitation care averaging from $300-700 per day. The state-run Medicaid program provides long-term residential care at $150-180 per day.
After an elderly patient is admitted to the hospital and treated for an acute care illness, usually for three to five days, they may require a longer stay for skilled nursing and rehabilitation. In most situations a patient is transferred from the hospital to a nursing home for their post-hospital care and Medicare will reimburse for these services for up to 100 days. Because the care center in Moab is not licensed for Medicare, these patients have to stay in the hospital. When patients are transferred from St. Mary’s back to Moab for post-acute care, they have to stay in the hospital. Even the patients who reside in the care center cannot go back to their rooms for the rehab portion of their care. They have to stay in the hospital.
Any long-term care manager knows that the worst place for a frail elderly patient is in the hospital. For quality care purposes alone, the care center should become a licensed Medicare skilled-nursing facility.
In my view, there are a couple of solutions that need to be investigated further before any suggestion of implementing a sales tax is considered. These options are as follows:
1. First and foremost is to change the license to include Medicare. Actively recruit long-term care experts to operate and manage the care center and provide an option to lease or buy the facility once the debt is paid off. As an incentive to the new management, the health care district could offer the vacant land it owns behind the new hospital and Grand Center to complete the vision of the MAPS project, which included senior independent housing and assisted living. The revenue from these new facilities could be used to subsidize some of the costs for the care center.
2. The other option, again, involves changing the license to include Medicare and letting the hospital manage the care center as it was originally intended. My guess is that Medicare did not allow the hospital to manage the care center because it was not licensed to accept Medicare. This issue needs further investigation. If there are other reasons Medicare will not allow the hospital’s involvement perhaps there is a waiver available.
Both of these options should be supplemented by private funding through the Friends of the Canyonlands Care Center. My understanding is this organization was established to raise funds to assist with improving the quality of life for the patients residing in the care center. Private/public relationships are quite common in this age of the declining federal dollars. This Friends group should become more pro-active in its fundraising campaign.
Clearly, there are other options available that the task force needs to examine further. But the most important step is to allow the care center to receive Medicare dollars. This action alone will go a long way in ensuring the success of the facility without having to place the burden on the taxpayer.
Joette Langianese has a master’s degree in gerontology. She was the chief Medicare/Medicaid compliance officer and long-term care consultant for Allen Memorial Hospital. Langianese served on the Grand County Council from 2001-2008, chaired the MAPS committee, and served on the Canyonlands Health Care Special Service District Board from 2002-2008. She is currently the executive director of a non-profit organization.