48 Comments - Carl Nyberg - Thursday, May 17, 12 @ 10:39 am: The world has gone insane. At least on paper, the U.S. economy is producing at a high level. The total GDP and the per capita GDP are high. The United States has the money to pay for military operations all over the world. Here’s the solution: tax the people who have money to pay for basics, like paying poor people to work in nursing homes to provide services. It’s disconnected from reality to think that some private sector employer is going to hire thousands of laid-off nursing home employees. We are creating (have created) an economy with little demand for labor. Corporations would rather build robots or hire people in the developing world. That’s reality. So, when the State of Illinois says it’s willing to put old people on the streets, remember it’s not being forced to do this. It’s choosing to do this rather than tax the Chicago Mercantile Exchange. On their way to Hell, hopefully the narcissists and sociopaths in the General Assembly all get voted out. - here's the thing - Thursday, May 17, 12 @ 11:08 am: People need to realize that the Medicaid cutbacks will affect health care for everybody. When a hospital downsizes its nursing staff, everybody has to wait longer to get their painkillers. When a nursing home lays off staff, all the patients are alone and uncared for a couple more hours each day. And bumping patients off Medicaid won’t save us as much as we hope — those patients will end up at our local community hospitals needing charity care that we’ll pay for through increased health insurance premiums. I’m not saying that there aren’t places to cut Medicaid, but you don’t lop off $2.7 billion without creating massive impacts throughout the state. - LTC Resident Advocate - Thursday, May 17, 12 @ 11:11 am: As an advocate for residents who reside in LTC facilities it is important for nursing homes to receive a reasonable and fair payment for their services so that a high standard of care can be given to our most frail and vulnerable population. Having said that, it is important to note that the Health Care Council of Illinois represents a majority of FOR PROFIT homes that have owners and top administration making ridiculous salaries therefore allowing them to buy more homes. In most cases, they are not passing the payments, whether from the residents own pockets or the pockets of Illinois citizens, on to the salaries of the front line staff; and this shows with the level of care that is being given. There are wonderful nursing homes in Illinois but I agree with Ms. Comstock with the added emphasis on fraud in the system but we must not forget the type of fraud that happens everyday by some of these owners and nursing home operators billing the state of Illinois and its citizens for substandard care delivery. - Dave V - Thursday, May 17, 12 @ 11:26 am: Rich, I agree there may be a finite amount that can be cut from some sources but cuts that drive people to higher cost venues for care is not a budget fix. It would be like saying I’m paying too much for my Ford Focus, I guess I’ll have to buy a Cadillac. People receiving home care through the Community Care Program or the Home Services program have the same eligibility when it comes to disability as nursing homes. So it doesn’t take a genius to see what will happen when they lose their home care services. And the difference is large in cost, on average the Community Care program costs the state around $800 a month, nursing home is around $3000. - lincolnlover - Thursday, May 17, 12 @ 11:30 am: The classic “don’t touch my services” “find somewhere else to cut” response. Who did you think they meant when they said “everyone” will hurt when we make these cuts that are necessary? - TwoFeetThick - Thursday, May 17, 12 @ 11:36 am: === So, when the State of Illinois says it’s willing to put old people on the streets, remember it’s not being forced to do this. It’s choosing to do this rather than tax the Chicago Mercantile Exchange.=== Mr. Nyberg, you are spot on. Well said. - Rich Miller - Thursday, May 17, 12 @ 11:36 am: Dave V, I get it. But the provider infrastructure needs to be preserved as well. - Cheryl44 - Thursday, May 17, 12 @ 11:47 am: So we can’t tax the rich because they are the job creators. We’ve been doing this for how long? And they’re not creating jobs, at least not here. Why don’t we try taxing them–we know they have the money, they’re intent on not handing it over via job creation, the government can take their money and hire people to do work like Mr Nyberg says up there. - 07Ombudsman - Thursday, May 17, 12 @ 12:09 pm: I understand that cuts have to be made. However, cutting from our society’s most vulnerable population is not acceptable. Nursing Home Residents have a right to quality care, to have there needs met and to be free from neglect (among several other rights). Nowhere in the law does it state that it is okay to provide substandard care because there is not enough staff or funding to provide the care. Yet this is what occurs and it is the excuse residents and family members hear time and again. - FormerGOPer - Thursday, May 17, 12 @ 12:24 pm: Back when I was a human services analyst in the House I became a big cynic of the argument of how much will be saved somewhere if we spend money here. While it can be valid argument sometimes, the State would be billions in the black if it were true as often as it is used. - CindyC - Thursday, May 17, 12 @ 12:31 pm: Nursing homes are already closing, but not due to funding, it is due to the fact that no one wants to live in one. The good people that work there do their best, but the model does not work. If you feed 30 people at the same time, with only 4 people to take them to the bathroom an hour later, half of them will be incontinent. Then those same 4 people have lots of linens to change. Truthfully, is it a tragedy to lose nursing homes? They don’t work. Let’s take care of our people at home–it’s cheaper, more effective, and kinder to workers. If the state would pay its bills, more adult day centers and home services agencies would open, hiring the same people that nursing homes hire, and expanding the care that could be done at home. IHCA may have a point, but is nursing home closures a loss? - Dave V - Thursday, May 17, 12 @ 12:36 pm: I wasn’t necessarily suggesting you should cut the provider infrastructure, I was just saying cutting $800 here and picking up $3000 somewhere else makes your hole bigger not smaller. - Freeman - Thursday, May 17, 12 @ 12:37 pm: Funny how the legislature always seem to find money and methods for things they want to… like Rep. Davis’ back rent and taxes. While that’s comparatively very small change, and will cost CPS money instead of the state, it’s only one recent example of many. The conversation coming out of Springfield goes something like this: “The state has no money! We need to cut services for the weak and vulnerable. We hope you understand.” “Wait, no, we can afford a $2 million live theater tax credit for Chicago. And a billion or two for other tax credits. And let’s crank up the EITC as well.” “OK, now the state has no money! We mean it this time!” “Wait no, the state has $10 million to clean up the Chicago River. It doesn’t count since it comes from Capital Funding.” “This time we really do mean it! The state has no money…” - Cook County Commoner - Thursday, May 17, 12 @ 12:40 pm: When I think of Medicaid reform, I think of that fine day in August, 1989 when a group of seniors chased Dan Rostenkowsky down Milwaukee Ave protesting what they perceived were negative changes to Medicare. The video is still out there, and I have to believe our stalwarts in Springfield review it regularly. For years they ignored the statistical certainty of gov pension and gov provided healthcare outstripping revenues. And now they face the liklihood of a significant backlash from the growing ranks of the sick and aged no matter what they do. There is no humane solution except convincing the electorate that clean and ethical government has arrived in Illinois and its local units, which in turn would convince citizens to accept a long needed progressive income tax. I find that unlikely in my lifetime,so our heros are advised to buy some running shoes. - Carl Nyberg - Thursday, May 17, 12 @ 12:51 pm: CindyC, what is your alternative to nursing homes for people who need significant amounts of care? Or are you just spewing Republican fecal matter? “Well, the Democratic solution is imperfect so we’ll just have to give the Republicans everything they want.” I’ve heard this argument before. And it always leads to heinous public policy and the Democrats are expected to clean up the Republican mess. - steve schnorf - Thursday, May 17, 12 @ 12:52 pm: I’m trying to get this straight: according to their lobbyists, people will be unable to get home care services because of lack of funding will cost the state more because they will have to go to nursing homes, who according to their lobbyists will have to close because of a lack of state funding. Right? - Yellow Dog Democrat - Thursday, May 17, 12 @ 1:04 pm: @Schnorf - Its a vicious cycle, isn’t it? @Rich - === As the governor says, everybody gets a haircut === On this point, academic experts and the voters of Illinois overwhelmingly disagree with you. According to a Pew poll, 70 percent of Illinoisans favor targeted cuts over across the board cuts. And budget experts point out that cutting cost effective strategies — especially prevention programs — equally with ineffective strategies is, well, a bad strategy. It’s kinda like trying to go on a diet to lose weight by eating 10% less candy and 10% less fruits and vegetables. You should probably eliminate the Reese’s Pieces all together and increase your fruits and veggies. To be clear, “haircuts” and “across the board cuts” are a political strategy, not a fiscal strategy. Part of the plan is that you can call your cuts “fair”. Part of it is to discourage all of the parties affective to keep quiet, with the implicit threat that things could easily be made much worse for complainers. And part of the strategy is to divide the resources of advocates so that they are fighting a war on many fronts. Its a good political strategy. We just should confuse it with anything that could be called fiscally responsible. Good luck, HCCI. - CindyC - Thursday, May 17, 12 @ 1:05 pm: There is always going to be a need for nursing homes for people who require significant care. But the bulk of people can be cared for in the community. What I am saying is that we need significantly less nursing homes than what we have. As more community based options become available, the need for nursing homes declines. Which is preferable and less expensive. Home and community based care is a win-win. Why should we pay for nursing home care when all some people need is a nutritious meal that they are unable to prepare themselves? Why pay for total care when we can just pay for the care that people need? - Yellow Dog Democrat - Thursday, May 17, 12 @ 1:08 pm: @Cheryl44 - Research has debunked that myth. Raising income taxes on the upper class and upper middle class has no measurable affect on migration. YDD - rwt - Thursday, May 17, 12 @ 1:13 pm: There has been much effort and studies cited to show that HCBS saves the State of Illinois money. It is the program that the state should be investing in to provide the needed services that seniors and those not able to help themselves. It also goes without saying that there are other areas that could result in savings for the state and thereby fund these services but that may affect the legislator themselves and that is not a step they are willing to take. It is not just the structure of HCBS that needs re-defining but also practices within our state legislature as well. It has been shown that HCBS is cost effective so the state needs to invest its limited resources and funds in that direction for the health and safety of the citizens of the state of Illinois - Emily Booth - Thursday, May 17, 12 @ 1:27 pm: CindyC, nursing homes are also rehab facilities. With our aging population, 10,000 baby boomers turning 65 every day, we will need more, not fewer nursing homes. Carl Nyberg, I applaud you! Brilliant! - AC - Thursday, May 17, 12 @ 1:33 pm: Further tax increases, that nearly everyone dismisses without thought, sound far more reasonable than the cuts to Medicaid. Add in the loss of federal dollars, and it seems unthinkable to make these sorts of cuts. Then again, I don’t think an additional tax increase is unthinkable. - CindyC - Thursday, May 17, 12 @ 1:34 pm: We can do most rehab at home, with less expense. Granted, when there is a need for skilled nursing in addition to occupational, physical, and speech therapies, it is more cost effective to do it at a nursing facility. However, rehab from a routine knee or hip replacement surgery is routinely done at home now. And as surgery continues to grow less invasive, recovery times will continue to shorten, not lengthen, allowing people to return home safely, more quickly. - TwoFeetThick - Thursday, May 17, 12 @ 1:38 pm: If these massive cuts become reality, the simple truth is people will die. Someone who needs care won’t get it, and it will be the end of them. So, instead of taxing the”job creators” at a level sufficient to maintain civil society, we’re letting the rich get richer while society’s neediest are allowed to wither away. I wonder what the cost is of all the special deals and tax breaks the State currently gives to corporations. Especially corporations that consistently have healthy profits. That wood be an interesting number to know. - TwoFeetThick - Thursday, May 17, 12 @ 1:39 pm: *would* - Freeman - Thursday, May 17, 12 @ 1:46 pm: === And it always leads to heinous public policy and the Democrats are expected to clean up the Republican mess. === 1.) A fair number of researchers, doctors, health employees and public officials believe that home and community-based services are not only more cost effective but also provide more attentive service to the needs of the aged, ill and disabled. Others contend the exact opposite - that larger facilities, while more expensive, offer a much but quality of life and better services than can be provided for some of our most vulnerable citizens in a home or community-based setting. I tend to conclude that community-based services are good for some, terrible for others. Regardless, both arguments make some excellent points. There are also members of both parties on each each side. There’s more to this than talking points. - mr. whipple - Thursday, May 17, 12 @ 2:03 pm: Bow much would be generated if Illinois taxed retirement income like it taxes all other income. Other states do it. The feds do it. The contributions made to an IRA and pension plans are tax exempt when made during the working years. And, in Illinois, they’re tax exempt when they’re withdrawn in retirement. I know it’s a tough vote. But it’s a lot easier to push the green button on this when the logic is unassailable. - Ellen Beth Gill - Thursday, May 17, 12 @ 2:23 pm: Remember that the brilliant changes to Medicaid, suggested by Democrats, but forced by the Republicans under the DRA passed under the Bush era and all the Medicaid cutting budgets pushed by Republicans in the US Congress, there will be fewer payments for in-home care. So, the sick and elderly will have no choice, but to go to nursing homes to get Medicaid benefits. - Carl Nyberg - Thursday, May 17, 12 @ 2:25 pm: I have no problem providing care in the community for people who would have their needs met that way. What’s the plan? Something tells me that cutting a few thousand beds to keep costs down is not going to result in sorting people in nursing homes by who can get care in the community. But I’m open minded. What standards are being advocated by the “care in the community crowd”? Or is this another situation where the Republicans and bean counters making grandiose pronouncements based on anecdotes and then real people are expected to successfully implement some half-baked policy ideas? - Yellow Dog Democrat - Thursday, May 17, 12 @ 2:42 pm: @TwoFeetThick- Corporate tax breaks cost the state $1.6 billion a year, last time I checked. Basically, enough to completely eliminate the Medicaid deficit if you factor in the cigarette tax and purging the rolls of ineligible folks. Without closing hospitals, nursing homes or community care programs, or denying the sick, elderly and disabled care. - Inactive - Thursday, May 17, 12 @ 2:43 pm: Taxing retirement income is hitting the same people who need the care we’re discussing eliminating for them! Less money to pay for the home health care or nursing home? - Anonymous - Thursday, May 17, 12 @ 2:48 pm: Serious question: Why is off-shoring of jobs never factored into or discussed when it comes to budgets and making tough decisions regarding cuts to social programs? Does anyone know of any reports or other publications out there that are comparable to a cost/benefit analysis from the government’s perspective (state and/or federal) that focuses in on off-shoring? I have a sneakin’ suspicion that that’s where alot of the money is for a variety of social programs. For example (and this is reality): When a company that “houses” employees in two suburban high rises, consolidates operations in that location ALONE into one tower because of constant “below the radar” lay-offs–and 50% of the remaining employees in the single tower are visa workers who make far less than the original employees, how much does that “cost” us in “missed tax revenues,” contributions to social security, unemployment, etc? Figure many of those who are RIF’d become the long-term unemployed or are underemployed at the same or lower rate than the visa workers and were making anywhere from $65,000 to $95,000 per year, were paying their share of various benefits (including healthcare insurance, long and short-term disabiity insurance, etc., spending money locally, and paying for mortgages. Then ID a fair multiplier that reflects the number of occurrences similar to this that take place across each state. That could be alot money, right? - Cam McAndrews - Thursday, May 17, 12 @ 2:49 pm: @LTC resident advocate For Profit is a bit of a misnomer when it comes to nursing homes. “For profit” homes are required to accept Medicaid patients. Some of the homes in IL are 90% Medicaid patients. That means the income for the facility is fixed. Many ‘Not for profit’ nursing homes have large private donations and are inhabited by people who have large discretionary income. - Anonymous - Thursday, May 17, 12 @ 2:57 pm: Sorry, I should have made the scenario clearer: -Two towers -Jobs in one tower completely off-shored -50% of jobs remaining in single tower now belonging to lower-paid visa workers who make about 50% (probably less) of what original workers made -Majority of RIF’d workers are long-term unemployed or underemployed Just generally speaking, that’s alot that used to be paid in taxes year after year after year…right? - Freeman - Thursday, May 17, 12 @ 3:04 pm: We definitely share common ground there, Carl. The plan of “cut the funding, kick them out and community and home providers will handle things” is no plan at all. Especially when many of the resources supporting those home and community based services are simultaneously being cut. There’s no perfect way to weather this storm, but some methods are better than others. “Damn the torpedoes, full speed ahead” constitutes neither a plan nor leadership. - Anonymous - Thursday, May 17, 12 @ 3:04 pm: Yeah…I’m going to guess it is. BUT I hope that the “officials” who let that happen on their watch, continued to collect all those campaign contributions directly or indirectly from ALL of the companies who are involved–especially from their buddies overseas–so that they could continue to shovel those dollars toward their friends and family here. (Good for them!) Carl’s wrong. The world hasn’t gone insane. There’s just something wrong with many of those who are supposed to be representing us. - Dave V - Thursday, May 17, 12 @ 3:06 pm: @Carl Nyberg Illinois actually leads the other states in low care need residents in nursing homes by a significant margin. So I would say yes the evidence shows other states have found ways to manage most of, at least those folks, in the community. Here is a source http://www.longtermscorecard.org/~/media/Files/Scorecard%20site/Illinois%20State%20Fact%20Sheet%20817.pdf You’ll find Illinois is listed as 49th but that is because Alaska did not report. - TwoFeetThick - Thursday, May 17, 12 @ 3:26 pm: @YDD Yep, that’s what I figured. Thank you. - NH Insider - Thursday, May 17, 12 @ 3:55 pm: The HCCI PAC is fairly large (according to the Illinois Campaign for Political Reform, in the 2011-2012 cycle, the Council has contributed roughly $580,000 and in the 2009-2010 cycly, about $1,300,000. This in in addition to contributions from individual homes and corporations in the long term care industry, and their vendors and suppliers. The nursing home industry, even homes with a high proportion of Medicaid residents are making money in Illinois. And yes, the acuity level is not as high as in other states. Ms. Comstock is correct that eligibility could be tightened. Those with lower DON scores could well be served in the community at much less cost. Perhaps the nursing home industry could increase wages for their own employees and decrease the size of their political contributions. Of course, this will never happen. - Carl Nyberg - Thursday, May 17, 12 @ 4:15 pm: Dave V, ok. What policies do you want to implement? Because what I suspect is being contemplated is to dump X% of nursing home residents (prevent them from being able to get into nursing homes) and leave the families to sort it out. - Dave V - Thursday, May 17, 12 @ 5:01 pm: @Carl Nyberg One that has been turned down has been a rescreening of residents 90 days after entry into nursing homes. This time period is when Medicare stops paying and the cost shifts to private or state payments. Since many people go in after running out of time in the hospital this would ensure they make decisions after they stabalized. Another policy we’ve backed is medication management in the community services. People that have trouble keeping track of meds end up going into nursing homes. The cost of this service in the community is much lower than having those people go into nursing homes. There’s more if you want them, but I agree they need to be giving more thought to the exit plan. But it’s important to know that the waiver programs for aging and physically disabled people are a lot more robust than what is being faced in the MI and DD populations, if your experience has been more the state facility closure discussion of late. - dave - Thursday, May 17, 12 @ 6:21 pm: **For Profit is a bit of a misnomer when it comes to nursing homes. “For profit” homes are required to accept Medicaid patients. Some of the homes in IL are 90% Medicaid patients. That means the income for the facility is fixed. Many ‘Not for profit’ nursing homes have large private donations and are inhabited by people who have large discretionary income.** Have you looked at the cost reports for these for-profit homes? They make profits. A lot of them. And then some more. Mostly by providing low-quality care. The owners of for-profit nursing homes sure aren’t in the business because of the kindness of their hearts. - dave - Thursday, May 17, 12 @ 6:23 pm: @Carl- hell…the first place to start would be not cutting community services. Dave V already mentioned a couple of specific proposals. You could also expand the current services offered in the communities. Home and community based services keep people healthier AND happier for longer, at a MUCH cheaper cost. Those programs already exist. Some of them need to be expanded to fully meet needs, but overall they absolutely help people stay independent and relatively health in the conusmers’ own homes. - dave - Thursday, May 17, 12 @ 6:26 pm: Oh…and to the point that HCCI made in the article about how NH liability hasnt significant gone up. This is because more and more people are choosing to remain in their homes and communities rather than be institutionalized. If we cut home and community based services, guess what is going to happen to that nursing home liabili? - Yellow Dog Democrat - Thursday, May 17, 12 @ 8:02 pm: @Inactive - I’m not aware of any serious proposal out there to hoax retirement income that doesn’t exempt at least the first $75K if not $100K. So, let’s assume you’re the former Speaker of the House and get a pension of $150K a year. You’d pay 5% tax on $50K (at today’s rates), $2500. For a net of $147,500. - Soccertease - Thursday, May 17, 12 @ 10:54 pm: Sorry to comment so late, but I’m actually dealing with mom going to the nursing home vs staying in her own home. Mom wants to stay at home and it seems to be better for all if she stays there and gets some home health care. Schnorf, I read your comment and think my dilemna affects a lot of people. - steve schnorf - Thursday, May 17, 12 @ 11:11 pm: tease, I think the dilemma faces most of us at some point. This is going to be painful, as are most of the cuts. However, I think back to two things during the Edgar administration. One was the ending of General Assistance for able-bodied single males early on, and the other was welfare reform in the mid 90s. I’m sure both of those were difficult for many of the people impacted. But in both instances we heard dire forecasts of babies starving, people dying in the streets for lack of care, etc, and, matter of fact, it just didn’t happen. People and systems adapted, as they will now. Not to over-simplify, but results are rarely as catastrophic as what is predicted by advocates for the spending, nor, to be honest, as mild as predicted by the opponents of the spending. - Kristen Pavle - Monday, May 21, 12 @ 12:03 pm: The research we conducted at Health & Medicine Policy Research Group is clear: other states who have cut Medicaid home care services, or who opted not to invest in home care services appropriately, saw an INCREASE either in costs of care, or an increase in utilization of ER, hospital and nursing facility services (more costly than home care). If Illinois cannot make decisions based on research and best practices across the country, we will continue to have the same dire fiscal consequences. Every legislative session. Let’s start now by making the right decisions: for Illinoisans, and our budget. Our budget deficit is too large reconcile in one fell swoop–we must dedicate ourselves starting now to investing in cost-saving measures, like home care. Sorry, comments for this post are now closed.