Finances a daily challenge for homes
BY GINNIE GRAHAM World Staff Writer & VALLERY BROWN The Oklahoman
Monday, February 22, 2010
2/22/10 at 1:04 PM
Reimbursement rates for residents at Intermediate Care Facilities for People with Mental Retardation may be dropped by about 3.25 percent as state lawmakers and officials scramble to fund state agencies during the current recession.
Residents of ICFMRs pay a portion of their living expenses with the rest being subsidized by federal Medicaid funds, which is a rate set by the Oklahoma Health Care Authority.
The rate is at $154.10 a day per person, but administrators say the actual cost ranges from $160 to $200 a day.
The Health Care Authority board had recommended cutting the Medicaid reimbursement to providers by 6.75 percent.
However, a budget agreement approved Thursday allocates an additional $33 million to the health care authority to offset the cut. Agency officials will go to the board in March to recommend rate cuts be held at 3.25 percent.
David Svedman, chief executive officer for Home of Hope in Vinita, said Medicaid represents nearly the entire budget in serving about 200 mentally retarded people. Employee wages account for about 80 percent of the budget. He said reductions will be difficult to overcome.
The rate includes costs for housing, utilities, medical bills, direct-care staff wages and insurance, over-the-counter medication, meals, physical therapy, transportation and vocational programs.
"There is such a great deal of ingredients going into the daily fee we get reimbursed for providing services to these individuals," Svedman said.
"That is why this cut would be devastating for us, who are already suffering financially. Unlike a hospital, doctor or some clinics, we do not bill insurance or private pay. We are 99 percent Medicaid funded."
To make up that difference, many homes hold fundraisers and seek grants.
Svedman said most fundraisers are for specific programs, such as Special Olympics, the equine program or work-placement programs, which are required by federal standards to promote independent living. Employee wage increases have ceased except for bumps if an employee meets a higher certification. Staff pay starts at $7.75 an hour.
"People should be making twice what they are making," Svedman said. "The unfortunate thing is that about 80 percent of our budget is for employees, and we have to maintain certain staffing ratios."
At Okarche's Center of Family Love home, about 30 employees during the past 15 years have received wage garnishments, most of those for defaulting on payday loans. Many have also filed for bankruptcy and received money judgments against them for other debts owed.
Executive director Jim O'Brien said he often has three to five employees at a time with wages being garnisheed. He said low government reimbursements do not allow homes to offer higher wages.
"They only average $8 to $9 per hour and can't make it," O'Brien said. "So they borrow from the small loan companies and then can't make the payments."
Staff turnover rates vary at homes, from 25 percent to 75 percent.
Information from the Oklahoma Foundation for Medical Quality, an organization that works with the Centers for Medicare and Medicaid Services, shows the turnover of certified nurse aides in the state is nearly 140 percent.
The ICFMR optional Medicaid benefit became available in 1972. Prior to this, mentally disabled people were placed in state institutions.
The philosophy emphasizes independent living in small homes with job and social networking opportunities.
When Judi Myers took over as executive director of Broken Arrow-based Gatesway in 2004, the organization was losing about $1 million a year, according to tax reports.
Home officials made staffing changes to shrink administration, sold homes in Sapulpa and Stillwater, closed a working greenhouse and cut down on services, such as lawn care, Myers said.
The home holds the Gatesway Balloon Festival and a golf tournament each year as a fundraiser.
The rising cost of health insurance for staff is the top reason for budget burdens, administrators said. Gatesway saw a $12,000 increase in one month, Myers said.
"We absorbed it," Myers said. "But what it does is absorbs profit that we use to make improvements."
Even the annual Christmas donations, which purchase gifts for the residents, have fallen from $15,000 in 2007 to about $5,000 last year, Myers said.
"Our people are adults; they are not elderly," Myers said. "They like to make friends and be in the community. Unless you have a job or a family member gives them money, they're not part of the community."
Finding job opportunities for residents, a federal requirement for homes, has been a challenge in a recession, administrators said.
The homes seek jobs through on-site workshop contracts or job coaching programs in the community. Residents at Home of Hope operate a car detailing shop, a thrift store and an on-site cafe, Svedman said.
"It's been a difficult year," Svedman said. "Being in the country has its disadvantages. In having to find jobs, Home of Hope had created businesses to employ people. All the agencies are having a difficult time finding enough jobs for clients."
At Country Lane in Beggs, vocational programs are expensive because of the transportation costs to Tulsa and other nearby cities and the program participation fees, said owner Scott Pilgrim.
"If push came to shove, that is the area we'd have to cut," Pilgrim said. "We'd have to cut out work to afford living."
Ginnie Graham 581-8376