California's nursing homes are getting better

By JAMES GOMEZ and DANIEL CIPPONERI

last updated: April 28, 2008 03:08:31 AM

The face of nursing home care in California is changing for the better. Some of the improvements are so obvious that they can easily be seen and felt. Some are subtle and not as visible yet, but they will be soon, as the markers are moving in the right direction. These positive changes are driven largely by the most significant overhaul of the state's Medi-Cal funding system since the program's inception in 1965.

The old system was an antiquated flat-rate payment system that paid all nursing-facility providers in a geographic area the same rate, regardless of individual patient needs or the cost of providing care.

As a result, it created a system that provided incentives to hold costs down and discouraged spending. The new system is based on common sense. It is incentive-based and is designed to reward providers for investing in increased pay for workers, improvements in the physical plant and enhancing direct services to patients. Providers who spend more in these areas receive a higher reimbursement rate. Providers who do not spend money on improving staff and services receive a lesser rate.

Advocates for seniors, organized labor, nursing home owners, Gov. Schwarzenegger and a bipartisan Legislature overwhelmingly supported this long overdue and necessary revamp of a 40-year-old system.

The transition to a completely new funding system has not been without its challenges. As with most monumental change, there is a learning curve, a level of expectable uncertainty and a concern that a change of this magnitude won't be sustained. In spite of these legitimate concerns, two important new studies tell us that the improvements sought by the revamp are becoming a reality in many of California's 1,400 nursing homes that provide critical short-term rehabilitation and long-term chronic care for more than 250,000 older Californians each year.

Today's nursing home patients fit into two primary categories. More than 65 percent come to us for intensive, short-term rehabilitation and return home or to a lesser level of care within 90 days, and

35 percent receive long-term care for age-related, multiple chronic conditions and spend the remainder of their lives in our care.

Whether our patients are with us for short-term or long-term care, adequate professionally trained staff is critical to their well-being. The Medi-Cal reimbursement overhaul, which was fully funded in 2006, was designed to provide nursing homes with the ability to increase staff, pay better wages and make much-needed capital improvements to aging buildings.

A study by Vanderbilt University's director of the Center for Quality Aging (January 2008) concludes, "We find that 26 percent of California nursing homes made statistically significant new investments in staffing and plant operations beyond projected trends during the first year that AB 1629 was in effect. ... Furthermore, there was a larger increase in average direct care staffing hours in most homes between 2005 and 2006 than in any year since 2001 and 2002 which suggests the possibility that a new trend may be beginning."

A 2007 benchmark study by the California Department of Health Services also illustrates that nursing home staffing levels and wages have increased steadily since 2002 and continue to improve.

The new system ultimately will be judged by consumers seeking the best long-term care providers for their loved ones. The health care consumers of today have much higher expectations than consumers of yesterday. They are looking for more choices, a more homelike environment and patient-centered care that supports our patients' individual needs and choices. Facilities that do not make these investments will not appeal to consumers, and the marketplace ultimately will dictate their future. The new funding system gives facilities the resources to make these changes.

Gomez is president and chief executive officer of the California Association of Health Facilities. Cipponeri is administrator of Evergreen Rehabilitation Center in Modesto.

• Comments
• Add Comment
• Disclaimer