State sales tax collections are cratering in a nasty little side effect to America's economic meltdown, and Gov. Phil Bredesen is doing what any former HMO executive would do: Cutting health-care benefits for some of the sickest people in Tennessee.
He's cutting in-home services for roughly 1,000 people, who all suffer from serious disabilities like cerebral palsy, muscular dystrophy, Parkinson's disease, severe brain trauma and strokes. They're currently allowed to live at home because Medicaid sends nurses to care for them. But if Bredesen succeeds, they'll be forced into nursing homes and hospitals.
If you haven't heard of these budget cuts, it's not surprising. On this topic, Bredesen delivers a decidedly sunnier message, boasting about expanding alternatives to nursing homes.
For decades, Tennessee has been dead last among states in these home- and community-based services. At the governor's urging this year, lawmakers enacted the Long Term Care Community Choices Act of 2008 so more of the sick and elderly can live at home.
The governor promised "we are going to fundamentally restructure how long-term care is handled in our TennCare program, and it will be a much better and more humane program as a result.... We need to make it easier to stay at home."
But while touting new services for some, Bredesen didn't mention that he would cut benefits for others.
Are these new cuts part of the governor's plan to create a more humane program? Believe it or not, the state government actually makes that argument in its response to a federal lawsuit filed by the disabled whose benefits are being reduced.
The lawsuit argues that the cuts violate the Americans with Disabilities Act, which forbids government from needlessly segregating disabled people from the community.Yet the state's lawyers ask the judge to look at the big picture. The comfort of some people may have to be sacrificed for the greater good, they say.
"The state does not desire anyone to enter a nursing home unnecessarily or contrary to his or her wishes," they argue, "and it did not make the decision to limit [benefits] lightly. It must be remembered, though, that those affected by the limits are the largest users of the most expensive types of home and community services Tennessee provides. The ability to limit costs by these users is essential to the state's ability to provide increased care for a greater number of disabled individuals in their homes and communities."
Costs have tripled in only the past three years because, the state contends, the recipients are gaming the system by relying on nurses for their care and letting family and friends off the hook. In-home nurses are available 24/7, and the state spent $103 million on these services in the past year. Officials expect to save $30 million in 2009 by curtailing them. That's hardly an overwhelming savings in the $28 billion state budget.
Yet state lawyers say Tennessee "simply cannot sustain this level of cost growth, especially in a period of falling state revenues arising from the current economic downtown."
Unchecked, the administration argues, these costs "could ultimately threaten the sustainability of TennCare itself, placing at risk the benefits of all of its 1.2 million enrollees."
Bredesen, who famously tossed 200,000 people off the TennCare rolls to save money earlier in his administration, maintains his latest cuts won't necessarily force anyone into nursing homes. But just in case that does happen, the state has helpfully calculated that it would save a lot of money. It costs close to $200,000 a year to provide around-the-clock nursing care at home, but only about $60,000 for each patient in a nursing home.
Patti Killingsworth, director of TennCare's long-term care program, says that by availing themselves of community-based services, these disabled people can stay at home despite the cuts in benefits. Selfishly, they're holding out for one-on-one care, she says.
"Even in a hospital setting, even in an intensive care setting, you do not have a nurse assigned to your bedside 24 hours a day, 7 days a week who cares only for you," Killingsworth tells the Scene. "People have gotten accustomed to that one-on-one kind of benefit. That kind of care is enormously expensive, and it's not going to be available anymore."
If the 19 plaintiffs in this lawsuit win, others might sue too, the state's lawyers warn. (Imagine that!) TennCare could then be "nickel-and-dimed to death," they say.
It's an unfortunate choice of words, considering that actual "death" may result from these cuts.
As lawyers for the disabled put it: "Plaintiffs face a cruel and impossible choice. They cannot afford to pay for in-home nursing out of pocket. Their family and friends already provide as much care as possible. As their Medicaid-funded service reductions go into effect, plaintiffs will be forced either to leave their homes and spouses, children, siblings and parents and go live in a nursing home, or they can stay home with grossly inadequate care that will damage their health and endanger their lives."
They further assert that Bredesen's plan won't save money. Clients will suffer new illnesses in nursing homes because of poor treatment, eventually forcing them into costly hospital stays. After all, Tennessee's nursing homes aren't known for quality care.
Violations are at an all-time high. Last year alone, they were cited for 152 "immediate jeopardy" violations—that is, violations that put residents in imminent danger of injury or death.
A date for a court hearing hasn't been set yet. The Tennessee Justice Center, an advocate for Medicaid patients, also has filed a federal civil rights complaint. The irony of the situation isn't lost on Gordon Bonnyman, the center's executive director.
"Here we have the governor and legislature saying, 'We are ready to join the 21st century by enabling people to remain with their families and to remain in the community,' " Bonnyman says. "They're saying they want to support families that are really heroically struggling to help people with really dire needs.
"Meanwhile, TennCare is saying, 'Hey you know what? These folks just cost too much and we've got an answer for them, and it's called a nursing home.' They're taking a simplistic meat-ax approach, and it's both dangerous and inhumane and economically foolish."
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I am a mom with a special needs child, my precious child has spastic cerebral palsy, medically fragile.He didnt ask for this condition, he cannot walk, but wants to, he cannot do as other kids, but would love to.As a parent I love my son, I dont love his condition. I can only say...Walk a mile in a Caregivers shoes, then make your decision...My son weighs 80 pounds dead weight, and I have found my health getting bad. So who will take care of me???
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