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« on: January 09, 2012, 09:34:20 AM »
See this article in today's Record. Medicaid funding seems to be drying up.
Day-care closure to leave seniors, disabled in lurch
Sunday, January 8, 2012 Last updated: Monday January 9, 2012, 6:38 AM
BY COLLEEN DISKIN
STAFF WRITER
The Record
One of the state's longest-running medical day-care programs for elderly and disabled residents is shutting down, a casualty of the growing funding headaches in New Jersey's long-term-care industry.
Staff member Ana Fernandes giving a gift bag to Dr. Hyman Levine at the Daughters of Miriam Center, which is ending the program in Clifton on Feb 3. Residents and their loved ones are scrambling to find other options when the Daughters of Miriam Center in Clifton closes the program on Feb. 3.
"I didn't sleep for two nights after they told us about it," said Susan Fenkanyn, 88, who has severe asthma that sometimes leaves her so short of breath that she has trouble walking.
It's possible that some of the center's 50 clients, particularly the 18 seniors enrolled in a day program for dementia sufferers, will have to enter a nursing home because their needs are beyond what family members can provide without some assistance, said Dr. Louis Chodosh, the program's medical director.
"There's no question that half of the people in the dementia program would be in a nursing home without the care they receive here," Chodosh said. If that happens with any of the Medicaid recipients in the program, Chodosh said, "it's going to cost the taxpayers and the government more money than it would to have them in this program."
Meanwhile, industry advocates warn the cuts to Medicaid and Medicare that are causing this program to close could force other facilities to cut their services.
The Daughters of Miriam Center is located in a building that also houses a 210-bed nursing home operated by the non-profit organization. It was one of the state's first adult medical day-care programs when it opened in 1975.
Such programs seek to offer the health monitoring and daytime companionship that can help keep seniors with chronic conditions from prematurely entering a nursing home. It is also an essential service to family members who need the help caring for their elderly loved ones.
The people enrolled in the program, and their families, were notified of the pending shutdown about a week before Christmas.
Carol Hamersma — whose 84-year-old mother, Betty, suffers from dementia and attends the program three days a week — said she was still absorbing the news of the closure and hadn't had a chance over the holidays to investigate other options.
The day program has been part of the patchwork of services Hamersma has pieced together to enable her widowed mother to remain in her Clifton home in spite of her disease's progression.
"We have some home care services that come to the house, and I stay over about two times a week," said Hamersma, a music teacher who lives in Woodbridge. "But a program like this is so worthwhile for her. It's part of being healthy that she has something to do. If she sits at home, it's the TV, and that's no substitute for getting out with people.
"Even if she doesn't remember all the names and the faces of the people,I can see that she's happy when she's here," Hamersma added.
Frank DaSilva, chief executive officer of Daughters of Miriam, said the non-profit decided to close the day program because it needs to plug a $1.2 million hole in its budget caused by steep Medicaid and Medicare reimbursement rate cuts to all nursing homes in the state.
The services provided by Daughters of Miriam's adult day-care program are not eligible for Medicare reimbursement, and only 21 percent of the participants are Medicaid recipients. So the program itself was not directly affected by those cuts. But DaSilva said the adult day care operated at a deficit the past decade and that the organization, which also operates independent living apartments for seniors, helped fund it with community grants and other donations it receives.
Now some of those donations — and money saved by closing the center — will need to be used to help keep the nursing home afloat. Like other nursing home administrators in the state, DaSilva was caught off guard when daily Medicaid reimbursement rates were cut by more than what was expected. In his facility's case, the rate dropped 5.3 percent instead of the expected 3 percent.
Since November, Daughters of Miriam also has laid off or reduced the hours of several employees to save what amounts to the salaries of eight full-time-equivalent workers, said DaSilva, adding that other cost-cutting measures will still be needed to address the funding shortfall.
Long-term care industry officials are plying state officials and lawmakers with requests to rescind at least a portion of those Medicaid rate cuts, but few hold out much hope that money can be found as New Jersey just went through a grueling year of budget cuts.
"This is one of many difficult choices that had to be made in balancing this year's budget," said Donna Leusner, spokeswoman for the Department of Health and Senior Services. "Medicaid funding for nursing homes represents nearly half of the budget of the Department of Health and Senior Services so it is very difficult to make cost reductions without affecting these facilities."
"Growth in New Jersey's Medicaid program coupled with a loss of federal funds resulted in a $1.4 billion reduction in the state's overall Medicaid budget, making program reductions necessary," Leusner said in a statement. "Unfortunately, this is the reality in states across the country."
At the same time that the state's Medicaid budget took a hit, the federal government also rolled back Medicare reimbursement rates to nursing homes. Industry advocates say they have no hope of winning back any of those federal Medicare dollars and instead are trying to get state lawmakers to realize that more facilities, besides Daughters of Miriam, may be soon be forced to cut services.
Daughters of Miriam staff members have spent the past few weeks researching alternative services for the 50 seniors, who attend the center between two and five times a week, depending on need. Just as it's possible that some of the sicker patients could end up in a nursing home, program directors say it's also possible that some of the healthier ones will resist switching to a new program where they don't know anyone. Those patients will end up spending more days alone, with their medical needs untended, officials said.
Fenkanyn, a longtime Passaic resident, said she doesn't think she will be comfortable in one of the alternative day programs recommended to her, because the participants there primarily speak Spanish. Instead, she's inclined to stay home this winter and "get started early on my spring cleaning" and try to find a new program later.
At 89, Herb Adelman is one of the healthier patients served by the program. He attributes that to the regular medical screenings hereceives from the nurse on staff. And he partly credits the regular company and recreational outings for his ability to live independently despite a heart condition that requires participation in cardiac rehab three days a week.
"They keep us busy here, and that's the point," said Adelman, a widower who still lives in the home he's owned for 45 years in Passaic Park. "That's what keeps me going."
Email: diskin@northjersey.com
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