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The future of long-term health care in this country will be bright - if the industry survives the next few years, according to the vice president of the American Health Care Association.

But nursing homes face critical problems because of continued dependence on Medicaid programs and an acute nursing shortage."We have had nursing shortages before," Dr. Paul G. Willging told members of the Utah Health Care Association. "This time, it's more serious. The pipeline is drying up . . . Nursing schools are closing and the number applying to the remaining schools is dropping dramatically."

Years ago, women who entered the work force had two basic career choices: nursing and teaching. Today, he said, women can choose any career. And a job that pays on average between $20,000 and $28,000 is not as attractive as other jobs.

Besides that, he said, "nursing homes have to overcome the negative perceptions Americans have about nursing homes. And nursing homes are at a serious competitive disadvantage (they pay about 65 percent of what hospitals can pay). We don't dispute nursing homes should have 24-hour licensed personnel (a federal requirement). But we have to be allowed to compete financially in order to pay for it. Congress must prohibit states from in any way capping the salaries.

To meet Medicaid standards for nursing home placement, people "spend down" - deplete their resources to the point of eligibility.

"People will eventually divest themselves of everything. If you need long-term care (the system) wants you to divest yourself of not only your assets, but your dignity."

Congress has attempted to deal with some of the major issues affecting the health care industry, Willging said, but efforts like the Catastrophic Health Care Act of 1988 don't deal with nursing homes. And nursing homes account for 81 percent of money spent on catastrophic health problems.

Congress is looking at three proposals that would affect nursing homes. One, sponsored by Sen. Ted Kennedy, D-Mass., would pay for the first six months of care in a nursing home (about $11,000), but would then leave it up to the individual to worry about the "true catastrophe" - a need for longer care.

The others would make the government responsible for the last dollars, rather than the first. But there are bugs to be worked out in both bills, Willging said.

Private industry has taken some of the burden. In the last few years, 80 companies have started selling long-term care insurance, and have issued over 500,000 policies. Most of the cost, though, has been absorbed by Medicaid programs and the nursing homes themselves.

The main thing to remember, Willging said, is that despite problems, nursing homes are still a bargain. Hospital costs average $572 a day nationally. A nursing home costs about $52.

"Nursing homes are the biggest bargain we have today. Unfortunately, the cost seems high because people don't stay just 4-5 days in a nursing home."