An amendment to a Wisconsin bill that would change the time attached to a senior living eviction notice would do little to address a “highly emotional and stressful time for everyone” and does not address the need for Medicaid reform, according to industry representatives.
SB 155 would extend the amount of time that Wisconsin assisted living communities, nursing homes and managed care organizations would have to notify residents of pending eviction or relocation. Introduced last fall, the original bill called for extending those notifications from 30 days to 90 days, but a recent amendment reduced the timeframe to 60 days.
All resident relocations are conducted with oversight from the state Department of Health Services, and communities and facilities must follow an intricate and detailed relocation process, Rick Abrams, CEO of the Wisconsin Health Care Association / Wisconsin Center for Assisted Living, told McKnight’s Senior Living.
“You can extend the notice or reduce it — it doesn’t address what is a highly emotional and stressful issue,” Abrams said. “The bottom line is, nobody is going to get relocated until a suitable, alternative placement is found.”
Abrams said that he has concerns that a perception exists that if a placement isn’t found in 30 days, then a provider is going to place a resident in a taxi and send the person away from a community, something he said is not true.
Relocations, he said, typically arise for one of three reasons: 1) the community or facility is closing, 2) a formerly private-pay resident has converted to Medicaid but the community or facility already is at capacity for Medicaid recipients, or 3) the community or facility was unsuccessful in negotiating a fair payment rate with the resident’s managed care organization under Family Care/Medicaid, Wisonsins’ home- and community-based waiver program.
The Family Care estimate in the most recent state budget used $13.02 as the median hourly wage for caregivers, whereas the current market calls for closer to between $17 and $20 per hour, Wisconsin Assisted Living Association President and CEO Mike Pochowski told McKnight’s Senior Living.
“Medicaid program cost inconsistencies like this have led to strains in provider reimbursement, a situation that has led some providers to exit the Family Care program,” he said. “The legislation is attempting to deal with a symptom of the actual problem, an underfunded Family Care program that does not recognize market wages and the true cost of providing care.”
SB 155, Abrams previously told McKnight’s Senior Living, does not address the surprise notice of discharge, which often is overlooked in admission agreements. Extending the notice, he said, is of marginal use in addressing the surprise factor for families and residents and is impractical from an immediate community/facility closure standpoint if the closure is the result of lack of operating funds, placing residents at risk of not receiving the care and services they need.
The extension, he added, also can provide an incentive for a managed care organization that is in the midst of negotiations with an assisted living community to walk away from the table earlier in the process.
Calling involuntary discharges “exceptionally rare and extremely unfortunate,” LeadingAge Wisconsin Vice President of Financial & Regulatory Services Rene Eastman shared her testimony before the state Senate Committee on Health. She said that if an involuntary discharge occurs for economic reasons, then member organizations “will always provide their residents with as much time as possible to secure alternative care and will do so at their own significant expense because it is the right thing to do.”
“The Family Care system is broken,” Eastman testified. “It fails to provide caregivers with a means to obtain reimbursement for services provided reasonably related to the cost of quality care. All too often, providers who threaten discharges are needing to do so as a ‘negotiation’ tactic to extract fair treatment from a managed care organization.”
Eastman said that this is why a minimum fee schedule for home- and community-based services in Wisconsin is needed.
“Family Care managed care organizations are too often reactive in care planning and not proactively planning for resident acuity level changes,” she said. “Provider regulations and caregiver shortages also place limitations on what can be done for a resident at any particular licensed setting.”
To make up for those Medicaid residents in the past, private-pay residents saw their rents rise. LeadingAge Wisconsin, however, said that such increases no longer are sustainable for those residents.
