RSSMedicaid not covering costs for some in assisted living
Jack Rush is middle-aged, developmentally disabled and Medicaid-eligible.But because the state doesn't pay assisted-living centers what it costs to take care of him, he's been told to find a new place to live. It's a growing problem statewide, but it's peYakima Herald-Republic
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John "Jack" Rush loves Western movies and bowling, which have been mainstays of his routine for the past eight years at Blossom House, an assisted-living center in Yakima.
But Rush, 55, who is developmentally disabled, has been told he must leave his home next month because his personal funds have been exhausted at the $3,200-a-month facility.
Although he's eligible for Medicaid, the government health services program for low-income people, Blossom House isn't accepting those residents any longer. The company that owns the facility says that at $2,000 a month, Medicaid doesn't cover the cost of taking care of people like Rush.
In short, he's being evicted, and he's scared.
"I worry about it every day," says Rush, rocking gently on the glider outside Blossom House on Nob Hill Boulevard, where he watches for fire trucks and police cars, sirens screaming.
Rush's story illustrates a collision between the bottom line of a business, competing demands on the state budget and an aging population that's living longer but running out of options for stable, long-term care.
Evictions of Medicaid residents from assisted-living centers has become a growing problem across the state, elder care experts say. The state Long-Term Care Ombudsman's office received 200 complaints last year surrounding involuntary discharges from long-term care centers.
About 75 were specifically related to facilities canceling their Medicaid contracts with the state or reducing the number of beds available to low-income tenants.
Although residents get help finding a new place to live -- typically a group home or skilled nursing center -- moving can cause "transfer trauma," leaving the elderly and disabled to think they did something wrong, according to Louise Ryan, the state's long-term care ombudsman.
Laurie Bebo, chief executive of Assisted Living Concepts, the Wisconsin company that owns Blossom House, said residents are prepared well in advance for a move in order to minimize disruption.
"We have always found appro-priate placement for people," Bebo said.
Companies like ALC that oper-ate assisted-living centers blame low Medicaid reimbursement rates, which in the state of Wash-ington rose just under one percent last year. Such centers, which cater to people who are relatively self-sufficient, lose $20 to $30 a day on each Medicaid resident, according to the Department of Social and Health Services.
Gary Weeks, executive director of the Washington Health Care Association, said this is an unsus-tainable business model.
"You can't run a business losing money on every resident on Medicaid and keep charging private-pay patients more and more," Weeks said.
"What happens is the private-pay folks spend their resources down and become Medicaid-eligible themselves. It's a cycle we can't seem to find our way out of."
Washington Health Care Association represents assisted-living centers and nursing homes, but not ALC. The company, based near Milwaukee, operates 21 facilities in the state, according to its most recent public report.
Weeks said he doesn't endorse ALC's decision to evict long-term patients moving onto Medicaid. "We don't support moving people out after they've been there for years," he said.
ALC made the news earlier this month when it tried to evict a 99-year-old woman from Franklin House in Sumner, Wash. The woman's lawyers are challenging the action, saying the family had been given verbal assurances for years that she could stay as a Medicaid resident after her own money ran out.
As a solution to the prob-lem facing Rush and others, Weeks wants the state Legislature to raise Medicaid reimbursement rates to assisted-living centers.
Sen. Jim Kastama, D-Puyallup, said that will be difficult with the state facing a $2.5 billion deficit.
"I don't think it's realistic to raise them a substantial amount. But I'm going to work on a way to make it more efficient and profitable for boarding homes to take
Medicaid residents," Kast-ama said.
Some advocates for the elderly say companies like ALC can be plenty profitable without throwing Medicaid residents out the door.
"Yes, the reimbursement rates need to be higher," said Ryan, the state ombudsman. "But at the same time we've seen corporations happy to let people in who pay more than the full cost -- and it is more than the full cost because these are profit-making corporations."
In 2007, ALC reported net income of $17.2 million, up from $9 million in 2006.
Rush's guardian, his brother Ed of Vancouver, Wash., has hired Yakima lawyer Marcus Fry to look into the circumstances surrounding the eviction. Fry questions a December 2007 residential agreement that Rush signed stating he would have to pay the private rate if there were no Medicaid beds available. Because Rush has a guard-ian, Fry explained, he can't
legally enter into a residen-tial contract.
In 2000, when Rush moved into the facility with his mother -- she had just lost her husband, Jack's father -- it accepted Medicare. After his mother died in 2005, Rush paid the full monthly fee from his inheritance. When that ran out two years ago, his siblings paid for his care.
But now they have ex-hausted their inheritances, which led them to apply for Medicaid on Rush's behalf. Mary Verhey, his sister, estimates the Rush family has paid Blossom House about $300,000 over the past eight years.
"We were trying to be responsible," she said. "We were responsible."
In May, Blossom House informed Rush in writing that no Medicaid beds were available and he began to accumulate an unpaid bill at the private rate. This month ALC sent him the eviction notice for failing to make payments of $2,649. Jack gets $678 a month in disability and all but about $60 goes to Blossom House.
In its eviction notice, ALC said the guardian had previously been notified of the new terms.
ALC's Bebo said the company is being painted unfairly. She declined to discuss individual cases, but she said the company historically has been one of the largest providers of Medicaid beds throughout its chain of 216 assisted living centers.
"I think people miss the big picture," Bebo said. "We haven't been focused on just the dollar signs. A lot of our competitors have never even been in the Medicaid program."
But Bebo also said assisted-living center residents have the same obligation as tenants to pay the rent.
"It's due on a monthly basis and if you stop, we don't have a contract where you pay this amount and we'll take care of you the rest of your life," she said.
In her 2007 letter to shareholders, Bebo said the company was making progress in its effort "to exit" Medicaid. Private-pay revenues represented 90 percent of the company's sales in the first quarter, up from 79 percent in 2006.
"We believe there is no doubt our strategy will benefit our shareholders, staff and residents in the long run," Bebo wrote.
Rush's role in the exit strategy is to move to an adult group home. His eviction notice says arrangements have been made to send him to Lincoln House at 46th and Lincoln Avenue. The home accepts Medicaid.
Verhey said she's not sure a group-home setting would appeal to her brother, who likely would have to share a bedroom.
While he functions mentally at the level of an 8-year-old and needs help with his medications, Jack is not high-maintenance, she said. He launders his own clothes and makes simple meals that don't involve cooking.
Rush enjoys his main meals in the group dining hall where elderly residents like to give him their desserts, Verhey said, and once a week he catches a lift with Dial-A-Ride to Minda Lanes to bowl.
Rush's siblings also have concerns about the quality of care at group homes and would rather see him stay where he feels secure in his routines.
"He needs a safe place to live," Verhey said.
* Leah Beth Ward can be reached at 577-7626 or lward@yakimaherald.com.
