Cutting Care; Enough is Enough!

Now that the dust has settled in Albany, there’s just one word that describes the impact of the recently adopted new state budget on long-term care:  Devastating.

No one argues that the state faced a considerable financial crisis that demanded a responsible response by the governor and state lawmakers.  Unfortunately, that’s not what we got.

The dire state of the economy notwithstanding, for most of this decade annual state budgets were pasted together with various resources, some of which, regrettably, were not of the recurring type.  This was the year, everyone knew well in advance, when it would be time to “pay the piper” for the spending structure that had been built on a foundation of singular revenues.  Of course, no one foresaw that economic turmoil that has beset the state, nation and world.

But then, to take it out on the wrong people?  A good share of what was done this year balances the state’s budget on the backs of the poor.  

I’m talking about frail older adults with chronic disabilities and persons living with HIV/AIDS, individuals who particularly rely on Medicaid to pay for the long-term care they need.  They are black men and women, women in particular.  Hispanic men and women.  They are men and women who have grown old never having a lot of resources, including those who now live in a city that’s one of the costliest in the nation.  Seniors with no place to turn.  They are people with HIV infection whose already difficult treatment regimen is complicated by substance abuse and mental health issues.

That is the face of those in need.  And that is exactly whom the state’s budget cuts impact most drastically and dramatically.

The state targeted long-term care this year for significant cuts, couching those reductions in the language of “reform.”  What has occurred, however, achieves very little in the way of true reform, while cutting deeply into the resources of providers who care for the most needy and frailest of our society.

This isn’t over.  More government cutbacks may yet be in store as the year goes on.  Meanwhile, a new nursing home pricing method based on “regional” costs that will be developed over the coming months is likely to be a blunt instrument being used by the state to further curtail residential care spending.  And, unless legislators by some miracle have second thoughts, nursing home rates for AIDS facilities such as Village Care’s Rivington House will lose a Medicaid reimbursement factor that has traditionally been employed by the state to help facilities address the complicated needs of patients who are HIV positive.  These are all individuals who are among the most frail, and the poorest, with complex care needs.

It’s time to say, “enough is enough!”

Enough harm has been done to the poor.

Enough has been taken away from frail seniors.

Enough has been eliminated from the care of those with AIDS.

More than enough.

We all want reform of care.  Village Care has for more than a decade taken on the mantle of reform, creating care for seniors and persons living with HIV/AIDS that is primarily community-based and which offers individuals the most opportunity and independence while giving them high quality services.

Village Care is not alone.  Throughout the long-term care field, it has been the providers who have tried to move from a system that shifts from a heavy reliance on costly institutional care and addresses care and cost from the perspective of patient need first.

Just a few days ago, I was in Albany to attend a reception honoring Carl Young, who has headed the New York Association of Homes and Services for the Aging for the past 20 years, and who will soon be retiring.

Carl talked about the way the term “special interests” is used so much these days in a disparaging way.  Special interests are bullied around as the cause of our financial woes, Carl said.  He went on:

“If special interests means frail seniors who need quality care and services…if special interests means making sure that persons living with HIV/AIDS have the care and treatment they need…if special interests means making sure that people have access to rehabilitation and home care, allowing them to continue to live at home, in the community…

“If that’s what special interests means, where do I sign up?”