Nursing News:
Federal cuts continue to threaten rural home health care

20,000 in Michigan stand to lose in Medicare reductions
By SHARON TERLEP / The Detroit News
BILLINGS TOWNSHIP ‹ Darren Seymour held Penny Dickıs arm as she walked cautiously across the living room, her breathing labored and an oxygen tube trailing behind. Seymour, a physical therapist, visits Dickıs home in rural Gladwin County twice a week to helps the 59-year-old heart patient rebuild her strength. In about two months, Dick has gone from being barely able to walk 10 feet to pacing the length of her home three times. ³I know Iım doing good when he says heıs going to discharge me soon,² said Dick, who has congestive heart failure and diabetes and also receives visits
from a nurse who helps monitors her medication. ³I donıt know what Iıd do without them. Iıd be in the hospital.² Itıs the kind of help that 20,000 of Michiganıs sick stand to lose in the wake of reductions in how much Medicare pays to treat people in rural areas, where homes are miles apart and the nearest hospital could be an hour away. Without home care, many patients would have to stay in a hospital or nursing home. Until last month, agencies that provided home health services to rural areas received 5 percent more funding than urban systems because of the time and gas it takes to drive between homes. Congress created the differential in 2001 as a 10 percent adjustment that ended in April 2003. It was reinstated for another year as a 5 percent adjustment and has since expired. The loss comes as the federal government struggles to trim ballooning Medicare costs.
Medicare spent 4 percent of its budget, about $11 billion, on home health care in 2003, based on the most recent data available. The extra cash amounted to hundreds of thousands of dollars for agencies like the Midland-based nonprofit that provides Dickıs care. The Mid-Michigan Visiting Nurses Association helps 400 patients a day in nine mid-Michigan counties.
Without the money, agencies nationwide are cutting back staff, eliminating programs and scrapping services to rural areas, which encompass nearly 70 percent of Michigan. ³The ones who are losing out are the ones with the least access to health care services,² said Chris Chesny, president of the Mid-Michigan Visiting Nurses Association. Already, the agency cut two counties, Iosco and Oscoda, out of its service area in late 2003 and eliminated 10 out of 140 staff positions. Losing the differential cut $232,000 a year from the agencyıs $11 million budget. Further cuts are imminent, Chesny said.
Residents who live in the Upper Peninsulaıs most remote regions also stand to lose home care services. Marquette General Home Health and Hospice, which serves about 500 people in the U.P., may have to stop taking clients who live more than 75 miles away. The agencyıs $7 million budget took a $350,000 hit with the loss of the differential, said Craig Chartier, director of home health for the agency.
³With everything else rising, this could have us operating at a loss,² he said. Statewide, 49 home health agencies that receive Medicare funding are in rural areas. The serviceıs goal is to keep seriously ill patients out of hospitals and nursing homes. Home care costs $100 to $200 a day, compared with $1,000 a day for a hospital stay and $166 a day at a nursing home, according to the National Association for Home Care and Hospice. Most home patients donıt need help daily. ³Sometimes weıre the only ones checking in on these folks,² said Seymour, as he made the half-hour drive to reach Dickıs Billings Township home 150 miles north of Detroit. He sees four to five patients a day and logs 150-200 miles daily in his Ford Focus.
Reducing reimbursements for rural care will result in higher health care costs because more people will be hospitalized, said Val Halamandaris, president of the National Association for Home Care and Hospice. Rural agencies on average lose about 6 percent a year, he said. ³There needs to be something to make up for that difference,² Halamandaris said.