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Mass. nursing care found lacking

State AARP director cites soaring cost

By Kay Lazar
Globe Staff / September 8, 2011

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Massachusetts ranks 30th of all states when it comes to overall affordability, quality, and availability of services for residents who need long-term care in a nursing facility or in their own home, according to a new national study.

The analysis ranked Massachusetts as one of the most expensive states in the country for the one in seven seniors who are paying for nursing home care out of their own pockets. Only Maine, Connecticut, Rhode Island, New York, and Alaska were rated more expensive, according to the report from the AARP Public Policy Institute and two other foundations.

Deborah Banda, state director of the AARP Massachusetts, said the findings underscore the urgent need for state leaders to address the soaring cost of long-term health care as they debate overhauling the way doctors and hospitals are paid.

“This really screams that we need to have affordability as a part of the discussion about payment reform,’’ Banda said.

The study also found that programs and services for families who care for loved ones at home are significantly lacking.

Despite a push by the Patrick administration to bolster home- and community-based care, the report gave Massachusetts low marks, ranking it 40th out of 50 states and the District of Columbia, for the percentage of low-income residents who end up in nursing homes without first receiving community-based care that might have allowed them to stay at home.

“This report tells us that we score very high on rhetoric but we are mediocre on performance,’’ said Al Norman, executive director of Mass Home Care, a network of 30 nonprofit agencies that focus on caring for patients in their homes.

“We tell the public that we want to take care of you at home,’’ Norman said. “But we don’t put our dollars where our rhetoric is.’’

The report found that Massachusetts spends about 39 percent of its long-term care money on services that would allow elders and disabled residents to be cared for in their homes, while the highest-ranked states allocate about 60 percent of their funds on home- and community-based care.

Dr. JudyAnn Bigby, the state’s secretary of Health and Human Services, said Massachusetts is committed to changing that equation and has improved since 2007, when it spent only 30 percent of its available money on community-based care.

Bigby said the state is hoping to create more community-based group homes for elders who need care but who prefer to stay in the neighborhoods where they have long lived.

She also said that the network of state and community agencies and organizations designed to help elders avoid nursing homes is fragmented and needs better coordination.

“There is more we can do about this,’’ Bigby said.

The report found that if Massachusetts improved its performance to the level of the highest performing state, Minnesota, at least 3,945 nursing home residents with minimum health care needs would instead be able to receive care in their communities.

“We want to draw attention to where a state is lagging, in relation to other states, and some of [these issues] you could fix easily, without spending money,’’ said Enid Kassner, a director of the AARP Public Policy Institute, who coauthored the study along with researchers from the Commonwealth Fund and the California-based SCAN Foundation.

For instance, Kassner said, states that received the highest overall marks allowed certified home health aides to perform a variety of tasks, such as administering certain medications to patients in their homes or helping them with feeding tubes.

Massachusetts law allows only registered nurses to perform most of these tasks. Kassner said such rules burden families who may be working and must hire registered nurses, in addition to home health aides, or dash home themselves each day to give a pill or an injection.

Legislation has been filed for four years that would allow home health aides to step in, but it has failed to pass.

The report gave Massachusetts nursing homes average or above-average marks in some areas, including the percentage of staff turnover and the percentage of residents with pressure sores - an indication that bed-ridden patients are being properly attended to.

But Massachusetts was ranked 35th nationally for physically restraining patients, an issue that industry leaders said needs to be addressed.

Scott Plumb, senior vice president of the Massachusetts Senior Care Association, said that since 2004 the industry has reduced by nearly half the percentage of patients who have been restrained. He said that nursing home administrators are worried about patients falling and being fined by state monitors for injuries from falls, prompting nursing homes to restrain patients too often.

“We are going in the right direction, but we aren’t where we should be,’’ Plumb said. “We should be better.’’

Kay Lazar can be reached at klazar@globe.com.