'Not disposable people': Patients on ventilators caught in the middle as nursing homes bleed money
The 36-year-old, who suffers from a rare muscle degenerative disease and needs a ventilator to breathe, urged a visitor to look at his wall plastered with posters of comic-book heroes, all given to him by Fox staff.
It's more than a community, said Boroughs, a big man who sprinkles conversation with gently sarcastic asides. "It's a family."
Last month, Boroughs learned that Fox had filed for bankruptcy and might go out of business without a state rescue. Since then, he has been experiencing anxiety.
"It's incredibly scary, the thought of losing your home. In my case, it's more scary because I can't just go find an apartment," said Boroughs, who moved out of his parents' house more than a decade ago because he wanted his independence.
Boroughs and hundreds of other
If the state can't come up with more money, providers warn that
While it's not unusual for nursing homes to bemoan low Medicaid rate, significant fallout has already started among nursing homes with beds for ventilator-dependent patients.
An additional 233 local ventilator beds at Fox and another facility that also takes only ventilator patients are in jeopardy, the owners said.
Statewide, there are 26 nursing homes that allot 921 beds for ventilator-dependent patients.
State officials say they are monitoring the situation affecting the nursing homes with ventilator patients and those with tracheotomies.
"Right now there are enough beds to meet the needs of people with need for vent-trache services, but that doesn't mean that will be the same condition three to six months from now," said
Funding struggles are not unusual in the world of Medicaid, where reimbursement rates are notoriously low, forcing providers to rely on higher rates from other insurers to subsidize Medicaid.
State officials have suggested that providers with only ventilator patients might benefit from taking some lower-cost patients who are not on ventilators. But, despite having that suggested patient mix, some
"We put in a self-imposed quota on the number of vent patients that we're going to have at any particular time, because we're ready for doom and gloom," said
Operators have long complained about insufficient rates, but what brought things to a head, they say, is a major change in the way Pennsylvania Medicaid pays for long-term care.
Instead of paying nursing homes directly,
Under the old system, rates were set based on costs. However, nursing homes typically would get paid 15 to 20 percent less than the rates, depending on the state's annual budget allocation for health care.
To prevent care disruptions as the new system started, the managed-care companies were required to contract with all nursing homes that took Medicaid and pay them per-day rates that were no less than those they received in 2018 under the old system.
Those rates were a floor under initial three-year contracts, state officials said.
Ultimately under the new system, the managed-care companies are expected to negotiate rates with nursing homes and other service providers. The ventilator specialists believed they would be able to get higher rates that way.
That did not happen, nursing home operators say. They say the three managed-care companies,
That was too much for Fox Subacute to take, after already losing
"We thought we would get it resolved when managed care came in. It didn't happen," said
Like Fox, Tulip Special Care, in the
That meant that the rate floor for Tulip did not capture the acuity of the patients it serves, said J. Edward Burleigh III, Tulip's CEO. "We're behind, and we'll never be able to catch up unless they renegotiate with us."
How long can Tulip hang on?
"It can't last too much longer," said
If Tulip can't survive, that would displace patients like Robert Hillsee, 66, from
"I can't stand," Hillsee said. "I'm just weak all over."
The only nursing home in
Facility administrator
An effort to help the facilities is underway in
State Sen.
"We were so hoping it would be something that would be a wonderful Christmas gift to a lot of these families who are extremely nervous and wary of what's going to be happening to their loved ones in these homes that are really financially strapped," said Bartolotta, who is cosponsoring the bill with Republican colleague
"These are not disposable people," said Bartolotta.
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