Better nursing home care tied to patients’ wealth

Patients in Washington nursing homes that care primarily for the poor suffer from a lower quality of life than those with more affluent clients, according to a study released by an advocacy group last week.

Patients in homes in Spokane and elsewhere that serve high numbers of Medicaid clients are more likely to suffer from bedsores and to spend most of their time in a bed or a chair. They’re allocated less time from caregivers and less money per day than those in nursing homes with more private-pay clients, according to the report by the Northwest Federation of Community Organizations, an advocacy group.

The result is an unequal system that unfairly penalizes poor seniors and their families, according to the study titled “In Search of Quality Care: Low-Income Seniors Left Behind.”

“All facilities need to have adequate resources to serve all seniors,” said author Gerald Smith, who called on Washington leaders to equalize reimbursement rates for private-pay and Medicaid centers.

“The state’s reimbursement rates need to be adjusted so that all patients are able to receive the best quality of care.”

Smith led the study that analyzed Medicaid enrollment and patient care in Washington’s 246 nursing homes, which served some 60,000 people in the state last year. The report included 16 nursing homes in Spokane County, whose Medicaid enrollment ranged from nearly 32 percent to nearly 80 percent.

The report found that nursing homes with high levels of Medicaid patients consistently delivered lower-quality care than those with higher levels of private-pay clients. For example, patients in homes with the highest percentage of Medicaid patients received an average of a half-hour less direct care each day and nearly $11 less a day in expenditures than homes with low levels of Medicaid enrollment.

About 4.4 percent of patients in homes with low numbers of Medicaid patients spent most of their time in bed or a chair, compared with about 6.5 percent in homes with high numbers of Medicaid patients. Nearly 11 percent of patients in low-enrollment homes suffered from bedsores, compared to more than 12 percent in high-enrollment homes.

Private-pay clients provide higher levels of revenue for nursing homes, partly because of the fees they’re charged. Nursing homes with high levels of Medicaid clients receive reduced fees because of their reduced costs.

“We’re very concerned that those facilities that care for a disproportionate percentage of the poor are caught in a Catch-22,” said Joshua Welter, organizing director for Washington Community Action Network (Washington CAN), one of the sponsors of the study. Washington CAN is a consumer-advocacy group dedicated to achieving economic fairness.

The report includes an anecdote about patient care at Regency at Northpointe, a Spokane nursing home with a reported Medicaid load of nearly 74 percent. Administrator Logan Stroud examined the report Tuesday, but did not return a call for comment.

Study authors vowed to lobby Washington Gov. Chris Gregoire and the Legislature to equalize reimbursement rates for nursing homes. A spokesman for Gregoire said Tuesday that staff members have received a copy of the recent study, but have not yet studied the concerns.