Health care progress slow
State's elderly, disabled still have few options
Thursday, June 24, 2004
By Bill Walsh
WASHINGTON -- Five years after the U.S. Supreme Court ordered states to give needy elderly and disabled people health-care options other than institutionalization, advocates and former high-ranking state officials say progress in Louisiana has been slow and met by much resistance.
According to the state's own figures, disabled people wait as long as eight years to get into a program that provides transportation and in-home nursing that could help them live more independently. At the end of last year, more than 3,200 elderly people were on a waiting list for a program offering minor home modifications and in-home assistance that could keep them out of nursing homes.
Figures show that Louisiana spends far more per capita on nursing homes and mental institutions than the national and Southern averages, and far less on home- and community-based services that studies show are cheaper and more beneficial to patients.
Despite Gov. Kathleen Blanco's stated interest in slowing that trend, only small steps were taken in the recent legislative session.
Blanco is expected to meet today with a task force in New Orleans to begin working on her health-care agenda, including her administration's plans on how to comply with the landmark antidiscrimination decision the Supreme Court rendered five years ago this week.
"It's very much a mixed picture," said Robin Wagner, project director in the Governor's Office of Disability Affairs. "There is progress, but Louisiana started off far behind and is still behind."
Olmstead v. LC
The Supreme Court's Olmstead v. LC decision, handed down June 22, 1999, said states violate the Americans with Disabilities Act when they provide only institutional services for elderly and disabled people who instead could be taken care of in their homes or communities.
Two years after the court ruling, little progress was evident in Louisiana. The state led the nation in the share of its Medicaid budget spent on institutional care, with 90.2 percent. In fiscal 2001, Louisiana had more institutional beds for disabled people per capita than any other state. And Louisiana was fourth in per-capita spending on nursing homes, shelling out more than twice the Southern regional average, according to state Legislative Auditor, Steve Theriot.
By fiscal 2003, the state was spending 16 percent of its long-term-care budget on home- and community-based services. The national average was 30 percent.
"I don't see much progress at all," said Kay Marcel, an activist whose son, Joel, is disabled and has been on a waiting list for services for six years.
"I see peoples' lives passing before me. They wait and wait," she said. "I've been doing this since Joel was 10. Now he's almost 26."
Others say that progress may be slow, but it's steady. Sixteen percent of the budget for home- and community-based services is an increase from 10 percent in 1999, according to state figures.
Since fiscal 2001, there has also been a 70 percent increase in the number of spaces available in a program providing in-home help to elderly, disabled people, according to the governor's office of disability affairs And the state has begun offering in-home personal-care assistance -- including bathing and meal preparation -- to low-income people. Those services are designed to allow people to live on their own with minimal outside help.
"I think over the past five years, Louisiana has made significant progress in terms of increasing the opportunities for people to have lives outside institutional settings," said Raymond Jetson, deputy health secretary.
But health advocates said the only progress made has been because of a lawsuit filed against Louisiana to expand home- and community-based services. The Barthelemy v. Hood suit, filed in 2000, which came to be known as mini-Olmstead, sought to force the state Health Department to follow through on the Supreme Court's decision.
A settlement contained explicit benchmarks for expanding noninstitutional programs.Those benchmarks are being met through the exanded programs.
"The Olmstead decision talked about steady progress," said Lois Simpson, director of the nonprofit Advocacy Center, which brought the Barthelemy suit. "The state has made progress because it was sued."
David Hood, former state health secretary and named as the defendant in that case, largely agreed. He said he didn't think the Legislature would have mustered the political will to expand services had its hand not been forced.
"I think it was probably a good thing we had the suit," Hood said.
Mark Drennen, former commissioner of administration under Gov. Mike Foster, voiced a similar sentiment.
"Why is it that we have so many people in so many institutions compared to other states? Why can't we make that transition?" asked Drennen, who now is president and CEO of the business group Greater New Orleans Inc.
Advocates of home- and community-based service long have argued that it is both cheaper and better for patients than institutional care. But Drennen said budget problems have stood in the way.
He said that creating new programs involves a substantial up-front cost that the Legislature hasn't been willing to swallow. Also, both he and Hood said the nursing home and private disability facility industries have fiercely opposed changes.
"The institutional providers are more entrenched in Louisiana than in other states. The nursing home lobby is very powerful," Hood said. "I think (elected officials) are really reluctant to make the switch" to community-based services.
Joe Donchess, head of the Lousiana Nursing Home Association, said the industry supports increasing the availability of home- and community-based services. But he said new services shouldn't come at the expense of existing ones.
He also predicted that offering noninstitutional services wouldn't necessarily reduce the number of people in nursing homes or facilities. Ultimately, he predicted, there would be a net increase in costs as more people sought services.
Perhaps nobody in Louisiana figures more prominently in the state's compliance with the Olmstead decision than state Sen. Joe McPherson, D-Woodworth. He is chairman of the Senate's Health and Welfare Committee and chairman of the panel created by the Legislature to develop a plan to comply with the Supreme Court decision.
McPherson's central role in policymaking is especially worrisome to health-care advocates because he is a nursing home owner. He invests in a facility in Lafayette.
"It's pretty disheartening," said Simpson of the Advocacy Center.
But McPherson said that as recently as the session that ended Monday, the Legislature made strides toward offering a broader array of health-care services to the elderly and disabled. At a cost of $1 million, 66 places were made in a program for disabled people who need emergency help in their homes, he said.
McPherson said the Olmstead decision never was intended to "steal" money from existing health services to finance new ones. He said the fact that the Legislature came up with $1 million to expand a program -- at a time when it was cutting Charity Hospital's budget -- shows that Louisiana is committed to abiding by the spirit of the Olmstead decision.
"In that extent, we are probably exceeding Olmstead," McPherson said.
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Bill Walsh can be reached at
firstname.lastname@example.org or (202) 383-7817.
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