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Newsroom
DETROIT AREA AGENCY ON AGING DETROIT – The Detroit Area Agency on Aging (DAAA) said today Detroit nursing homes are facing a crisis that threatens the future of long term care in the city. The agency said an 18-month system review revealed that nursing home closures, a disproportionate number of Medicaid-dependent facilities, and the perception of poor quality of care in Detroit all are working together to jeopardize the long term care system in the city. It issued a series of recommendations to turn the situation around and ensure a quality care system in the city for those who need long term care. The agency’s Detroit Long Term Care System Change Task Force found three core problems that contribute to the city’s long term care crisis. The core problems are:
Other challenges include a need to improve financial reimbursement policies, developing more service support for nursing home residents, and recruiting and retaining a qualified direct care staff and work force. “Older adults and individuals with disabilities need our help,” said Paul Bridgewater, President and CEO of the Detroit Area Agency on Aging. “The long term care system in Detroit is failing the most vulnerable members of our community, threatening their quality of life to age with grace and dignity. We’ve identified key areas that will be presented to our Legislature including issues with Medicaid, facility improvements, and training options that we hope will transform and renew the grim long term care system as we know it in Detroit.” Funded by the Michigan Department of Community Health, the new findings build on the agency’s 2004 report Dying Before Their Time: The Startling Truth of Senior Mortality, which found that over a 10-year period approximately 17,000 Detroit seniors died at an earlier age than their counterparts in suburban facilities because they do not have access to quality long term care that would extend their lives. Research teams from the Wayne State University’s Center for Urban Studies (WSU/CUS) and the Detroit Medical Center/Wayne State University (DMC/WSU) Community Health Institutes contributed to the study. In the latest research, the task force found at least 16 nursing homes in the city have closed in the last 13 years, roughly one facility per year. Facilities close because of financial difficulties, often due to low reimbursement rates, understaffing and high turnover, and buildings that are outdated. Residents of closed facilities face the risk of suffering “transfer trauma” which often results in depression, serious illness and elevated mortality risk. Bridgewater said another problem is that long term care facilities in Detroit struggle financially due to the high number of Medicaid residents and low reimbursement rates. Medicaid-dependent facilities are often unable to collect patient pay amounts that are the patient’s responsibility. These bad debts go unreimbursed in the payment system creating an additional burden for urban facilities. An average facility in the city has 82% residents covered by Medicaid, compared to 68% statewide. “Many nursing homes in Detroit are caring for the poorest of the poor,” said Bridgewater. “They have limited personal resources and are relying on Medicaid as the primary source of payment to seek care.” The task force also found the quality of long term care services in Detroit nursing facilities are of much better quality than other parts of the state, but are perceived as poor because of the outdated physical conditions of urban facilities. As such, Detroit nursing homes are losing a large resident base to suburban facilities. In 2008, 5,341 Detroit residents were admitted to a nursing home. Of these, 2,351 or 44% were admitted to a Detroit facility; 2,990 or 56% were admitted to a suburban facility. There were 583 suburban residents admitted to Detroit facilities. “The outflow of nursing home residents to suburban facilities and closures is lost revenue for Detroit,” said Bridgewater. “The city loses income on employee wages that would have been earned and property taxes that would have been generated if new facilities were built. Additional revenue from residents through Medicaid, Medicare and private funds through Detroit facilities would have been $118 million in added revenue for the city in 2008.” The task force of more than 100 academic and long term care experts and stakeholders compiled the research into Transforming Long Term Care in Detroit-A Synopsis of Findings from the Detroit Long Term Care System Change Task Force outlining the urgency for change in the long term care system as a result of their findings from focus groups, knowledge and opinion polls, nursing home studies, best practices and consumer surveys. Plante Moran LLC, the University of Michigan Geriatrics Center and the Institute of Aging Research contributed to the synopsis. Immediate actions the task force recommends to transform long term care in Detroit include: Problem #1: Detroit nursing homes are closing at a high rate of roughly one facility per year with no new construction on the horizon. Recommendation: Support the development of new facilities, including continuing care retirement communities in order to elevate expectations of consumers and increase the competitive pressure on existing providers to reinvest. Problem #2: Detroit nursing homes are dependent on Medicaid funding, placing long term care facilities in financial constraint. Recommendation: Create a disproportionate share payment mechanism for those facilities who serve a higher proportion of Medicaid residents, similar to that provided to hospitals. Eliminate or modify reimbursement regulations to encourage spending on operations and reinvestment in facilities. Enhance the efficiency and response time of the Medicaid eligibility approval process, thereby speeding up the receipt of payment. Problem #3: Detroit nursing homes are battling an image problem: the perception that long term care in Detroit is second-rate at best. Recommendation: Increase resources available for training direct care staff as well as management staff. Establish a system of oversight for guardians to ensure older adults and individuals with disabilities are represented appropriately and funds are spent properly. Create a community advocacy network to educate and engage the community as a whole on issues related to long term care services. About the Detroit Area Agency on Aging |
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