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The Honolulu Advertiser
Posted on: Tuesday, June 24, 2003

Seniors' stays in hospitals shortened

By Deborah Adamson
Advertiser Staff Writer

Starting July 1, the state Department of Human Services officially changes a long-standing policy that had left dozens of Medicaid patients stuck at hospitals waiting to be placed into a senior care facility.

Department director Lillian Koller has authorized the flow of money between Medicaid and the Medicaid Waiver program, effectively speeding up the transfer of hospital patients to alternative care homes.

"Let the hospitals have their beds available for emergencies," Koller said.

Medicaid pays for nursing home care for indigent patients. Medicaid Waiver's Residential Alternative Community Care program pays for Medicaid-qualified patients who opt for alternative care facilities, such as elder care homes.

They provide intermediate custodial care as well as skilled nursing services. Intermediate care is needed when a senior cannot perform such daily activities as bathing. Skilled nursing care typically is for bed-ridden patients with specialized medical needs.

Because of bureaucratic restrictions, patients were kept waiting at hospitals if the program's budget couldn't accept more people even if alternative beds were available, Koller said. The new rule lets people bypass RACC's budget restrictions and use Medicaid money for alternative centers.

As of March 31, there were 176 wait-listed people needing intermediate and skilled care staying at hospitals statewide, according to the Healthcare Association of Hawaii.

The RACC program has nearly $10 million at its disposal for fiscal year 2003, which ends June 30. But the program already stopped accepting new patients a year ago because it can't accept more.

Currently, 400 people can be supported, said Pat Snyder, administrator of the department's Social Services Division. But RACC actually supports 600, with unused money taken from other Waiver programs to pay for them, she said.

"It's not enough," she said.

Koller's decision, which shifts some Medicaid money toward RACC, has resulted in 30 people leaving hospitals, Snyder said.

That's good news for Anne Trygstad, project coordinator of 196-bed Maui Memorial Medical Center. On any given day, between 30 and 50 beds at the hospital are taken up by seniors waiting to be placed.

"It's affecting the delivery of acute care on the island," Trygstad said.

Acute care covers immediate medical needs, such as when someone develops pneumonia and needs to be treated.

Medicaid patients stay in the hospital from a day to more than a year before being moved, depending on their medical and other conditions, she said.

By letting patients move out of hospital beds more quickly, the state is saving money, she added.

It costs the state about $1,000 per person daily for hospital care, Trygstad said.

That's 10 times more than what elder care homes cost, she added. Her hospital loses $15 million a year caring for these patients, Trygstad said.