Congress and Washington state must figure in impacts on long-term care in reform efforts

FOR the past 34 years, Snohomish's family-owned Delta Rehabilitation Center has specialized in caring for patients — as young as 14 — with traumatic brain injuries (TBI).

Such injuries are beyond the norm for most skilled-nursing-home care, which makes Delta a special place. A severe brain injury commonly begins with a car crash. That's what happened to 20-year-old Mike Walsh in June 1975.

On Highway 2 a drunken driver smashed Mike's VW Bug. Clinically dead, Mike was resuscitated by the responding state trooper. Mike's coma lasted seven months. Mike's parents — who were running Delta — took him into the nursing home.

Mike was Delta's first TBI patient. However, he inspired his parents to serve brain-injury survivors. Today, Delta is one of the nation's largest, and oldest, providers of such care. And Mike Walsh, who was headed to prestigious Northwestern University after that 1975 summer, still resides at Delta — where his brother, Chris, holds the administrator job Mike planned on having someday.

Given the complex care required by such patients (Mike can neither verbally communicate nor walk), it's remarkable Delta received all five stars in the most recent federal nursing-home quality rating.

Regrettably, the state is not as committed to maintaining quality. In a 1995 article about Delta, The Seattle Times wrote, poignantly, that "[s]ince the medical phenomenon of brain-injury survival is still so new" the state's Medicaid payment rates "haven't yet caught up." Fourteen years later, that's still true.

Even worse, this past session the Legislature — while, paradoxically, sparing its private dining rooms from cuts — reduced Medicaid reimbursement for skilled care at facilities like Delta by $8.67 per patient to an average of $156.37 a day (Delta would be at a scant $133.52).

Properly using an extra $87 billion in Medicaid assistance from the federal stimulus package, most other states maintained, or even increased, nursing-home funding. (Incredibly, neighboring Oregon pays over $50 per day more than Washington). That's solid economics. Because roughly 70 percent of nursing-home costs are labor-tied, reducing payment for them — and surrendering federal matching funds — takes money out of your economy.

It's ironic that if Mike Walsh had committed a crime, instead of being the victim of one, the state would better fund the care of a citizen like him. The average cost per prison inmate in a medical bed is $163.68 per day — substantially better than what the state nursing home reimbursement will fall to.

Further suffering is signaled by huge federal cuts pending to Medicare. Medicare pays for roughly a tenth of all nursing-home patients, following hospitals stays. Its payments are higher given that post-hospitalization care is more acute. It has long been understood that Medicare payments, along with private-paying patients, cross-subsidize the failure of state governments like Washington's to pay Medicaid costs.

Yet Washington's severe Medicaid cuts may simply foreshadow things to come. Buried in a 439-page federal rule change is the decision to slash Medicare rates effective October 2010. If Congress fails to block this, and the cut is compounded by Medicare cuts in pending health-care-reform legislation, Washington's nursing homes would see daily Medicare payment rates drop by more than 9 percent — an estimated $34.24 per patient.

Unfortunately, this very real threat to the elderly and those with severe disabilities has been lost in the manufactured hysteria over "death panels" and other non-issues.

While hospitals agreed to Medicare cuts in health-care reform assuming they'll make more if all patients are insured, nursing homes, which see little private insurance with over two-thirds of patients on Medicaid, would have no such reprieve.

If Congress allows this to occur, the last thread of the safety net for Washington's most vulnerable will unravel. And Mike Walsh will have fought to live an honorable life — only to see government's neglect force unendurable hardship at the special facility he once dreamed of running.