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Valley nursing home displaces 14 as Medicaid reimbursements fall

Published: Fri, November 9, 2012 @ 12:10 a.m.


MaryAnn Steerman holds a note expressing her frustration at the news that Valley Renaissance Healthcare Center is discharging her and 13 others because the respiratory-care unit is being closed, a move that is happening more often because of Medicaid and Medicare reimbursement cuts.

By Doug Livingston



Fourteen residents will have to find a new place to live by next Friday because Valley Renaissance Healthcare Center, a nursing facility on South Avenue, is planning to end its respiratory-care program.

The move is part of a growing trend in which nursing homes eliminate services for high-risk patients who require high-cost treatment, especially in light of cuts in Medicaid and Medicare reimbursements.

Most of the affected residents rely on a ventilator to breathe. Several cannot talk or must plug the tracheotomy tube protruding from their neck with a finger to speak.

Their treatment can be costly, experts say.

Gene Gantt is a respiratory therapist with 30 years’ experience and the chairman of the long-term care section of the American Association for Respiratory Care. He said facilities discontinue high-risk services such as respiratory care when Medicaid reimbursement rates fail to cover costs.

Medicaid in Ohio underwent cuts in 1999 and 2011.

“We had seen a trend of [respiratory-care programs] closing down after 1998, when reimbursement changed, and then there was a surge between 2009 and 2011, and now we’re starting to see some of the units closing in states where reimbursement is lower than the cost of care for these patients,” Gantt said.

Mike Fishel, 45, a Valley Renaissance resident who is being displaced, has fallen prey to this trend for the third time. Originally from Summit County, he had to move from Little Forrest Rehabilitation Medical Center (now University Park Nursing and Rehab) in Akron and The Arbors at Canton (now The Laurels at Canton) because those facilities also closed their respiratory programs.

He and resident Doris Floyd have appealed their discharge. Hearings were conducted Monday at Valley Renaissance, where an arbitrator appointed by the Ohio Department of Health will weigh arguments from administration and affected patients.

The hearing officer should have a decision within five days, but Fishel shudders at the possibility of having to move to another facility yet again.

“Most of the people in here, they can’t articulate for themselves. It’s screwed up. But they have no say over anything. They have no power over anything,” Fishel said.

MaryAnn Steerman, president of the facility’s resident council, already has begun to pack. She has lived at Valley Renaissance for three years. Her respiratory illness renders her incapable of talking. But it isn’t her inability to speak that hinders communication with administration.

“They don’t tell us much,” she writes on a tablet.

Steerman chose not to appeal and to move to Canal Pointe in Akron.

“Other ventilator units have closed in the area. But this is the first one where we’ve seen — at least that we’ve been informed [of] — that there are more than a dozen people involved at one time,” said John Saulitis, who, as an Ohio Department of Aging ombudsman, advocates for long-term care residents in Mahoning, Trumbull, Ashtabula and Columbiana counties.

He had urged Valley Renaissance residents to appeal the “eviction notice” because under state law residents can only be involuntarily discharged if they are a danger to others, have not paid their bills or if they are well enough to return home.

“Usually it’s a dollar-and-cents kind of issue,” said Daniel Van Dussen, director of gerontology at Youngstown State University.

Van Dussen said Medicaid reimbursement rates play a major role in outsourcing high-cost treatments such as respiratory care.

Over the past year, Medicaid reimbursements for Ohio’s 958 nursing homes have been cut by 5.8 percent, which is expected to save taxpayers $360 million over two years.

The cuts were made in an attempt to promote quality care by returning some of those funds only if quality measurements were met, according to the governor’s Office of Health Transformation.

Medicare and Medicaid use a formula, which includes levels of patient care, local tax rates and quality measures, to determine how much each facility will be reimbursed per day.

Therefore, cuts at Valley Renaissance resulted in a 6.66 percent decrease in per diem Medicaid funding. So, while the facility received $160 per patient per day in 2011, it gets only $152 per patient per day in 2012.

This year, the average statewide daily reimbursement rate for nursing homes is $167, a number Gantt said is too low.

He said when Medicaid reimbursement rates dip below $500 a day, costs begin to exceed revenue, and nursing homes are forced to decide whether to continue costly services such as respiratory care.

Michael Rescineto, the administrator of Valley Renaissance, in a faxed statement, discussed the difficulty in making such a decision.

“As the individual who started the respiratory program 11 years ago here at Valley Renaissance Healthcare Center, it was an extremely tough decision for me to make to discontinue this service. ... At no point will a resident be left without a place to go.”

What’s happening to the residents of Valley Renaissance happened to the residents of Heather Hill nursing home in Chardon more than a decade ago when respiratory care was cut.

In that case, Cleveland attorney Janet Lowder represented a 15-year-old resident, who enrolled in Heather Hill’s ventilator program after being struck by a vehicle. Another patient was struck with polio as a child and required ventilator care to breathe.

Lowder, a certified elder law attorney through the National Elder Law Foundation, worked the case pro bono. She filed an injunction to keep the residents in the facility. The case was settled before the appeal hearing, but as Lowder built a defense for her argument, her notes suggested that Heather Hill’s rationale for closing the respiratory-care program was financially driven.

“Ventilator care is unique in that it requires such specialized care, and it is a costly program to run,” Lowder said. “Long-term care facilities are not required to offer this type of program. It doesn’t hurt their license if they don’t have a ventilator program.”

Rescineto and Provider Services Inc., which owns Valley Renaissance, did not comment directly about why the Boardman facility discontinued the unit.

The discharge notice did give residents three possible locations — Caprice Healthcare in North Lima, Beachwood Pointe near Cleveland, and Canal Pointe in Akron. The latter two are part of the Provider Services family, which also owns more than 100 other facilities across Ohio, according to the company’s website.

Other facilities that offer respirator care include Andover Village Retirement Community, Andover, in Ashtabula County; Autumn Hills Care Center, Niles, in Trumbull County; and Calcutta Health Care Center, Calcutta, in Columbiana County.

TheNewsOutlet.org is a collaborative effort among the Youngstown State University journalism program, Kent State University, The University of Akron and professional media outlets including, WYSU-FM Radio, The Vindicator, and The Beacon Journal and Rubber City Radio, both of Akron.


1gr8bnretired(21 comments)posted 3 years, 8 months ago

Shameful! How much do the owners of these "care" facilities rake in? What do the stockholders and investors earn quarterly? How long until this tragedy happens to those of who are presently healthy? With dollar signs dancing in their heads, these facilities... SOME of which may as well be warehouses storing goods to be traded for profit... might just move the residents to the parking lots, arrange their beds under colorful flapping banners and sell them to each other like used cars!

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2sewingnut(33 comments)posted 3 years, 8 months ago

As Obamacare starts to be fully implemented you will see more of this. People that will not be able to afford the required health insurance will be eligible for Medicaid. Having worked for a health care provider I know Medicaid reimbursements are dismal. It will come to the point when providers will decide not to accept it. As Medcaid is currently set up for providers it's either an "all in or all out" scenerio. If you accept Medicaid as a payor you can't pick and chose what paitients you want to treat.

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3paulparks(235 comments)posted 3 years, 8 months ago

Thanks, Obama!

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4ytownsteelman(680 comments)posted 3 years, 8 months ago

The cuts were necessary to help eliminate the state deficit. Ohio should not have offered all of these services in the first place, and now people are upset that they are being taken away. Be thankful for what you got when you got it. Its different world, money isn't flowing in to the state like it used to.

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5nojimbo(286 comments)posted 3 years, 8 months ago

krissps is right. But of course knowing nothing about the subject of a story doesn't stop the "armchair scholars" from throwing their two cents in.

It would be nice if someone could wake our local state representatives and senators from their post election celebrations and have them go to bat in Columbus for these residents. As they said about JFK's book, "A little less Profile and a little more Courage" from our local guys who get reelected forever whether they do anything or not.

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6sewingnut(33 comments)posted 3 years, 8 months ago

1.The Act was designed to reduce overall health care costs by making services available to the 32 million who currently can't get insurance. They often use a hospital emergency room as their primary care physician, increasing costs for everyone. This starts in 2014.
2.For people who can't afford health insurance, the Federal government will pay the states to add them to Medicaid. The income requirement is expanded up to 133% of the Federal poverty level .

Gov. Kasich had nothing to do with the Federal govt. mandates.

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7paulparks(235 comments)posted 3 years, 8 months ago

Obama's anti-life philosophy trickles down to Ohio - now - and for the next 4 years. Wait till Obamacare is fully implemented.

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8Tonytimber01(2 comments)posted 3 years, 8 months ago

Here we go..... I remember Nancy Pelosi saying "to know what is in the bill, you have to pass the bill first! Folks you had a chance to stop it with your vote election day and you didn't, Elections have consequences, and this is just the start.

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9walter_sobchak(2713 comments)posted 3 years, 8 months ago

Medicaid is a FEDERAL program that is erun according to FEDERAL guidelines. It is funded by both the federal and state govt and it is administered through the individual states. But, the guidelines are federal. Now, all states are required to have a balanced budget, unlike the federal budget. So, when Kasich took office, he was staring at a very large budget deficit and cuts were made because, unlike the federal govt, the state of Ohio cannot just keep printing money. But, at this point, to blame it on Obama or Obamacare is just plain incorrect.

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10Peregrine(47 comments)posted 3 years, 8 months ago

Another good article under the auspices of TheNewsOutlet.org.

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11DaddyD(24 comments)posted 3 years, 8 months ago

Paulpark-Damn can you let this Obama Sh#$@T go. The man is back in office. SUCK IT UP AND MOVE ON !!!!! We have him for the next 4 years and then he's gone. Then you'll be whinning about the next President!!!!!!!

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12redeye1(5660 comments)posted 3 years, 8 months ago

DaddyO Whats a matter? You are now seeing the future results of your vote for BO and you don't like it. TOO BAD! You and all the others who voted for him must now share in the blame. I have friends who are nurses and they are being told that there is a really good chance that they will be laid-off due OBAMMY care. You see, I'm one of them people who actually sat down and read the whole Obammy care bill. Just wait its going to get worse too. As you said in an earlier post SUCK IT UP AND MOVE ON!!!!!!!
remember that statement okay!

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13harleydog(243 comments)posted 3 years, 8 months ago

They call this OBAMACARE. All you people who voted to re elect the fool are getting what you deserve. This is only the tip of what is going to happen.

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14paulparks(235 comments)posted 3 years, 8 months ago

The greatest deceiver in the nation is Barack Obama:

1. Women have never been worse off - a philosophy the democrats enshrined in their abortion platform.

2. I hate to say it - but we have truly become of country of "good v. evil." And the concentration of atheistic gay-marriage "in your face" - life is not worth very much if you are infirm, disabled or old - is in the democrat party. This party even wanted to take God out of their platform. (The Republican platform was prolife.)

3. There are many sensitive, intelligent, caring people who have bought into the "Culture of death" ideals of the democrat party... Too bad.

4. Our country is going further into the trashcan the next four years - just watch!

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15redeye1(5660 comments)posted 3 years, 8 months ago

gdog If anyone is a horse's arse its you. . Why did they wait to let this people go now? Because OBammy Boy won the election, that's why , They already know what the future cuts are going to be. How you might ask? They sat down and read the whole Obammy care bill just like I did. Something that maybe you and all of your liberal friends should have done too. But No, Obammy knows all and he won't screw us. WRONG!!!!!!!!

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161fastsuv(1 comment)posted 3 years, 8 months ago

gr8bnretired I'm sure you would continue to provide services at a charge much lower than your costs? Doing that, it would only be a matter of time before bankruptcy, and everyone had to go.

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17pmeoh(6 comments)posted 3 years, 8 months ago

For those of you who seem to blame everything on the Affordable Healthcare Act, I suggest you actually read it before you continue your bias. The cuts here had nothing to do with Obamacare. Ohio is one state that has failed to take any action with respect to Medicaid expansion or medical exchanges. The current reimbursement rate which is causing these displacements is a product of the Kasich administration. You can thank him for this particular piece of bad news.

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18rocky14(838 comments)posted 3 years, 8 months ago

paulparks--I'll bet you wake up everyday hating yourself and the world.
Why don't you do everyone a favor and do away with yourself.

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19paul21045(28 comments)posted 3 years, 8 months ago

Hey PAUL PARKS THE BOTTOM LINE IS YOU LOST, THE VOTERS SPOKE, LIVE WITH IT. . . . and this first showed up during Bush I

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20redeye1(5660 comments)posted 3 years, 8 months ago

pmeoh I did ! Did you? This is only the first step towards a downward spiral without end. Medical costs are rising faster now then ever, if this bill was to slow things down. It isn't working.

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21lee(544 comments)posted 3 years, 8 months ago

Yes we lost. Remember elections have consequences. I do know who John Galt is and I think he is coming

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22joydav(41 comments)posted 3 years, 8 months ago

This is a sin and a shame that this is happening to these people. This nursing facility isn't one of the best out there. Instead of trying to find a way for these people to remain where they have been for years, you worry about Obamacare. If it wasn't for "ObamaCare" they may not have any CARE at all.

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23jojuggie(1723 comments)posted 3 years, 8 months ago

Romneycare in Mass. is 70 pages long.
Obamacare is 2100 pages long.
'nuff said.

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24DSquared(1788 comments)posted 3 years, 8 months ago

You ain't seen nothin' yet. Wait 'till ODumbo Care kicks in. As Big-ears said, "Maybe you shouldn't have surgery, Just take the pill" You wanted it, you got it now. Enjoy!!

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25Tonytimber01(2 comments)posted 3 years, 8 months ago

Nope under Obama Care, the needs of the many outweigh the needs of the few. So Obama and his death panel will pull the plug on them.

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26DontBanThisDrone(1046 comments)posted 3 years, 8 months ago

We need to eliminate this Currency thing from our civilization.

Bicker on drones.


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