People with Alzheimer’s and other forms of dementia who live in special sections of adult care homes – and use Medicaid to help pay their bills – face a funding cut that jeopardizes their specialized care.
Family members and owners of adult-care homes – a state designation that includes assisted living facilities – hope that a recently filed bill will fend off those cuts. Special-care units provide higher levels of staffing and attention for people with dementia, for whom bathing, dressing and other care can be especially difficult and time-consuming.
Medicaid payments for special-care unit residents were reduced this year as part of a larger change in how people quality for help bathing, eating, and dressing.
More than 20,000 people living in adult care, family care and group homes for people with mental disabilities face new limits and stiffer qualification standards. That number includes about 2,500 people in special-care units, according to the state Department of Health and Human Services. Industry representatives put the number closer to 4,000.
The new Medicaid rules limit personal care to 80 hours a month per resident. Adult-care home operators say they were sending in bills for 124 hours a month, on average, for those residents under previous guidelines. The legislature allowed operators to tap in to a state fund to help bridge the gap, but that money runs dry on June 30.
Rep. Nelson Dollar, a Cary Republican, filed a bill last week that would allow people with Alzheimer’s disease and other forms of dementia to receive as much as 130 hours of personal care services each month.
The increase would require approval from the legislature and the federal agency that oversees Medicaid and Medicare.
A family’s plight
Rufus Parsons, 91, has lived in a special-care unit since last July, when a doctor told him he was in the early stages of dementia, said his daughter, Kathy Privette of Wendell.
“He got sick the first of July. He didn’t know how to use the phone. He couldn’t call for help,” she said.
Privette’s mother had dementia and was in an assisted-living home, for which the family paid all the expenses, Privette said.
“It doesn’t take long to go through your savings when you have one parent like that,” she said.
If the extra hours for special-care residents aren’t approved, Privette worries that her father will be moved to a room where he’ll receive less care and supervision.
“I know my dad won’t go there,” she said. “I’ll do whatever I can to take care of him.”
Conflicting policy goals
The federal government picks up most of the costs for Medicaid, the government health insurance for the poor, elderly and disabled. Any state changes require the federal government to go along. Dollar said he hoped the federal government would see the urgency.
Sen. Ralph Hise, a Spruce Pine Republican and co-chairman of the Senate health and human services budget subcommittee, said the legislature would have to consider how any changes to Medicaid for people with Alzheimer’s would fit with the plan that Gov. Pat McCrory announced last week. McCrory wants Medicaid recipients to enroll in health plans managed by companies that receive a set amount of money for each patient.
Advocates, family members and the industry want quick action.
People with Alzheimer’s need more attention than other adult-care home residents, said Alice Watkins, executive director of Alzheimer’s North Carolina Inc.
“Facilities are saying they aren’t going to take any more Medicaid patients,” she said.
Alzheimer’s North Carolina is part of a group called the N.C. Alliance for Alzheimer’s Care that is pushing the state to increase the monthly limit. Two assisted living companies, the state’s assisted living trade group and a Henderson-based pharmacy are also part of the alliance.
Special-care units require more staff than regular units in adult-care homes, said Karen Moriarty, CEO of Carillon Assisted Living. The new, 80-hour limit meant operators lost about $1,000 a month in Medicaid reimbursements for each special-care unit resident, she said. The suggested change would resolve the funding problems, Moriarty said.