“It’s awfully hard to stay in business if you don’t get paid,” said Linda Milholland, director of Windsor Place, Iola’s only nursing home.
In the world of healthcare, what may seem self-evident often has some leeway.
But with cuts to Medicaid looming in the U.S. Congress, administrators such as Milholland will be forced to grow a second skin when it comes to admitting residents.
“We may be forced to take a closer look at a resident’s assets before taking them in,” she said, something anathema to a physician’s Hippocratic oath: “Do no harm.”
HOW DID it get to this?
First off, of Windsor’s residents, 68 percent depend on Medicaid to pay for their care. Medicaid is the federal/state program that assists the elderly poor as well as those with disabilities and the indigent, many of whom are children.
In Kansas, Medicaid was not expanded under the Affordable Care Act to help cover this demographic, so nursing homes, hospitals, mental health facilities, etc., were left to assume more of their expenses.
To make matters worse, Kansas has reduced its payments to nursing homes. Today, Medicaid pays 51 percent, or $184.50 a day, of what it takes to adequately care for a resident at the local facility, according to Milholland.
A restructuring of services also created a backlog of applications to nursing homes. Previously, the local Department of Children and Families would process a resident’s application to receive Medicaid.
“That could be done in a matter of hours,” Milholland said of the former method.
Today, however, the state’s Department of Health and Environment handles such applications — required to be submitted over the Internet.
For applicants, that has meant delays and more hoops to jump through.
“We had applicants waiting six months to see whether they would be approved,” said Marian Conaway, a nurse and director of human relations at Windsor. Federal law requires that states process Medicaid applications within 45 days. Last summer, the number caught in the backlog totaled 15,000.
Most times the nursing home would go ahead and admit the resident, taking the risk they would be reimbursed for their care further on down the line.
“We were waiting for hundreds of thousands of dollars to come through,” said Milholland. “That’s not a sound business model.”
The backlog forced administrators to re-evaluate their admission procedures.
“We used to be a lot more lenient. Today, we’re more cautious to make sure adequate funding is lined up,” Milholland said.
While most of that backlog has been caught up, the nursing home’s numbers remain depressed. Today, they have 40 residents with 50 possible spaces. Statewide, occupancy is 60 percent in nursing homes.
Backlog or not, the funding is not there.
Windsor Place is the only nursing home in Iola ever since the Iola Nursing Center closed in 2015. Humboldt’s Pinecrest closed in 2011.
Moran Manor exists as do two in Chanute, Heritage Health Care and Chanute Healthcare Center.
NATIONWIDE, 64 percent of nursing home residents are on Medicaid. Nursing homes depend on reimbursements to take care of these residents. Typical costs for a resident are $5,000-$6,000 a month.
To qualify for Medicaid, a resident’s assets must be less than $2,000.
The average duration of a resident’s stay is two years, but “we’ve had some for eight years,” which can become a financial burden for families, said Milholland.
Of all Medicaid spending, 40 percent goes to nursing home residents. As a program, Medicaid is larger than Medicare, the federal government’s program for seniors.
“When we look at the future, the challenges are even greater,” said Conaway, referring to the generation born on the heels of World War II, the baby boomers, who are now entering their 70s. Coupled with little savings, it’s a generation that will increasingly rely on social programs such as Medicaid.
The two administrators are holding their breath as to what Congress will eventually decide on healthcare. Windsor Place hangs in the balance.
