Nurses Forced To Discharge Medicaid Patients

Voices of nurses are almost completely missing in the national and state level debate on health care, which is not a surprise. I suspect that many nurses put the energy that might have gone to policymaking into their daily nursing practice instead: sending a card to the grieving spouse of a patient or taking charts home at night to complete on the kitchen table.

I can't speak for all nurses, but here's the perspective of one nurse, with more than 10 years of community nursing experience, on why the current Connecticut Medicaid cuts hurt all state residents.

As a refresher, Medicaid is a federal program that gives health coverage to millions of low-income Americans, especially seniors, those with disabilities, children and pregnant women. It is managed, however, by each state. Here in Connecticut, Medicaid reimbursement rates (that's what the government pays a health care provider for caring for a Medicaid patient) have often been below the actual cost of providing care. Because of these low rates, many physicians' offices have stopped accepting Medicaid patients or severely limited the number they accept.

On Aug. 11, the Department of Social Services made cuts to home care reimbursement rates, which impacted six nonprofit home care agencies that care for some of Connecticut's most vulnerable seniors and people with disabilities. Because of these changes, I am among the many nurses who have had to discharge some Medicaid patients.

So why should this matter to you if you have private insurance? Needing Medicaid is very much a "there but for the grace of God go I" situation. Medicaid home services often are the difference between a person being able to stay home or ending up in a much costlier nursing home, paid for by the state. Besides hurting patients who could be you or me or a loved one, these shortsighted cuts will cost the state much more in the long term as more people are placed in nursing homes, end up in emergency departments or have worsening health outcomes. Every Connecticut taxpayer will shoulder those additional costs.

The majority of my Medicaid patients are seniors who also have Medicare, but their limited retirement income means Medicaid is used for the co-pay for their prescription drugs, co-pay for doctor's appointments and home care services. One of my patients is an 84-year-old man who worked hard all his life and raised a family in Connecticut. He now has late-stage Alzheimer's, meaning he rarely speaks a word, is bed-bound and needs full care for all activities, including eating, dressing and hygiene. His wife provides amazing and loving care to keep him home, in part so that the great-grandchildren who live next door can visit and light up his face.

I provide a comprehensive assessment of this patient twice a month, to ensure possible pressure ulcers are prevented and any agitation or pain is assessed and treated. As I prepare to discharge him from my home care agency, his wife expresses sorrow, in part because she had hoped he could have the same caring providers he's gotten to know until the end of his life.

Another Medicaid patient is a retired psychiatric nurse. Her severe spinal stenosis leaves her homebound and in chronic pain. It is her home health aides, paid by Medicaid, coming several times a week helping her with washing and dressing, who allow her to stay in her apartment with her cat, instead of in a nursing home on the state's dime, at a much higher cost to taxpayers.

While technology and pharmaceuticals save lives, so do relationships between the health care provider and patient. As long-term patients are discharged from home care services because of the state Medicaid cutbacks, my colleagues and patients and I are shedding tears. Emotional responses aside, there will be entirely predictable worsening health outcomes for many of these patients. Those ultimately will cost the state even more money.

Connecticut needs to fully fund Medicaid, including home care agencies, for both improved health outcomes of its citizens as well as budget savings for all taxpayers.

Melody Wright lives in the Pleasant Valley section of Barkhamsted and works for Visiting Nurse Services of Connecticut.

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