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Nursing home residents risk losing bed

State Medicaid cut may force facilities to readmit elderly, disabled to new rooms

By Kay Lazar
Globe Staff / July 30, 2011

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Massachusetts nursing home residents who are briefly hospitalized or leave to visit their family risk losing their bed under a state funding cut finalized yesterday that illustrates the tough choices confronting state government in an era of tight budgets.

Advocates for the elderly and disabled worked feverishly for a last-minute reprieve, but the state’s Medicaid director said he had few options.

“I certainly appreciate the concerns raised by residents, advocates, caregivers, and members of the Legislature, but given our budget constraints, we had to move forward with this decision,’’ Dr. Julian Harris said in an interview.

The new rule goes into effect Nov. 1, Harris said

Federal law requires nursing homes to readmit a resident after a temporary leave to the first available bed in a shared room, but it does not guarantee the same room or bed as before.

Because so many nursing home residents have dementia, the prospect of facing a new bed and room each time they return can be especially confusing, advocates said.

“Imagine the stress this will put on families, heading into the winter holiday season, and they’re thinking, ‘I will have to tell my loved one that I won’t be able to bring them home for Thanksgiving because they’ll risk losing their bed,’ ’’ said Debbie Banda, director of the Massachusetts office of AARP, a major interest group representing older Americans.

Massachusetts Advocates for Nursing Home Reform, a statewide consumer group, collected petitions bearing nearly 1,600 signatures in hopes of persuading lawmakers and the Patrick administration to save the program and seek cuts elsewhere in the state’s $10.3 billion Medicaid budget.

The $9 million program, in existence for more than a decade, pays nursing homes to reserve a resident’s bed for up to 10 days. The state and federal government split the cost.

“There will be devastating consequences to residents if they lose their beds in the place they call home,’’ said Arlene Germain, the group’s president.

Senator Mark C. Montigny, a New Bedford Democrat, said he fought the cut because he remembered the trauma that engulfed his family when his father was repeatedly hospitalized while in a nursing home in the early 1990s, sparking concerns about whether his bed would be saved.

Montigny said his father formed such close bonds with his nursing home caregivers that he insisted on calling them when he came home for Christmas.

That experience spurred the lawmaker to successfully fight for a rule that held nursing home beds for 20 days; that was later whittled down to 10.

“I have seen a lot of cuts in tight times,’’ Montigny said, “but this latest one is about as bad as you can get.’’

In 2010, there were 28,854 occasions when a bed was held for a nursing home resident whose bill was paid by Medicaid, according to state figures.

Patrick administration spokeswoman Jennifer Kritz said the number of people who used the bed-hold provision was probably significantly smaller because the same person may have needed a bed reserved multiple times.

Harris, the Medicaid director, said when the administration was studying the potential impact of the cut, it found 4,000 to 5,000 empty nursing home beds in Massachusetts on any given day. That, he said, would make it more likely that patients returning from a temporary leave would be able to return to their former room.

But advocates and nursing home operators said residents who live in homes that specialize in specific types of care, such as for younger, disabled people or for Alzheimer’s patients, face more competition for beds in highly sought-after facilities.

Advocates said they will continue to fight the cut this fall when lawmakers consider a supplemental state budget plan.

“We have made a direct appeal to the Senate Ways and Means chair [Stephen Brewer],’’ Montigny said, “and I believe we have a fighting shot. What I heard from Steve was a compassion to change this.’’

Kay Lazar can be reached at klazar@globe.com.