In February Governor Quinn released the state’s 2012 budget which contained a 6% cut in Medicaid reimbursements for nursing homes.  This amount which equals about $70,000,000 would be a statewide cut according to the Health Care Council Of Illinois (HCCI).  Worse yet, the state will lose its federal matching funds if it cuts Medicaid.  This means that nursing homes, statewide, will lose $140,000,000 in funding.

According to Pat Comstock executive director of HHCI says that with the proposed budget cuts to Medicaid, the mandates passed in July 2010, won’t mean a thing. “The cuts are for care provided to residents on Medicaid, so not only are they our sickest citizens; they’re our poorest citizens.”  “The state plans to reduce what they pay for that care without changing their care expectations.  They just expect a facility like this to do more with less, but we’ve been doing more with less for years.  We can’t just absorb this cut.”

The Illinois Constitution requires that the Governor authors the state’s budget and then submits it the Illinois General Assembly, which then “shall make appropriations for all expenditures of public funds by the State.”  For the 2010 and 2011 budget the General Assembly approved “lump sum” appropriations giving the Governor to spend those as he sees fit.   For the 201 budget,  the legislature will attempt to negotiate a line-by-line budget.  This means that groups like HCCI will have to lobby lawmakers, individually, for funding.

John Reich, 74, whose wife Phyllis 70 is a patient at Capitol Care Center in Springfield, believes that the cut in spending could ultimately lead to the closing of the nursing home.  “If they closed this place down or made it so I couldn’t take care of my wife, I don’t know what we would do.  I don’t have answer. I just hope there’s some other answer than cutting this.”

In Illinois, the cost for a room in a private nursing facility has risen 3.8% annually compared to 4.4% nationally.   The average rate for a private room in Illinois is $63,875 per year compared to $77,745 per year.

Negotiating with care providers:  It never hurts to ask

Because competition is stiff in local markets, consumers may have the power to negotiate, particularly with assisted living facilities and home care agencies.  Family members should not be afraid to address the cost of care and whether these costs can be reduced.

Know what to ask: Tips for Reducing Care Giving Costs

While nursing homes are reluctant to reduce their costs because of their dependence on Medicaid/Medicare, assisted living facilities and in-home agencies have more room in negotiating their rates.  Keep these things in mind when negotiating the costs of long term care.

Know local costs: Consumers can plan for the costs of long term care by using Genworth’s Financial Cost of Care Map.  The map provides the median cost of care nationally and in certain areas within Illinois.

Fee Waivers: Consumers may be charged a one-time move in fee by an assisted living facility. If the facility has several vacant units or they have stiff local competition, they may be willing to waive the fee.

Special Rates: If a resident agrees to move in on the first of the month or at a time when the facility has a higher vacancy rate,  you may be able to get a “special rate” from the facility.

Vacancy Rates: If the facility has a high vacancy rate, they may move the resident into a more expensive room at a lower price.

Lower Hourly Rates: If the patients requires long-term case which is easy to staff, a home health care agency may reduce their hourly rate.

Shop Around: Check out rates at several different agencies.   If an agency knows that you are shopping around they may be willing to negotiate a lower rate.  If the rates of the competition are lower, let them know that.

Premium Waivers: Home care agencies often charge a premium for weekend services.  If a significant amount of care is needed weekdays as well, the agency may be willing to waive the weekend premium.

Ask for an Upgrade:  Nursing homes generally do not reduce their rates.  You can, however, ask for a room upgrade or extra amenities for the same rate.

Most complaints can be resolved by the staff and the director of the facility.  But if the issue is too big or the facility isn’t taking the appropriate action, you can contact the Illinois long term ombudsman.

The Illinois long-term ombudsman is a group of advocates for residents receiving care in a long term facility.    By investigating complaints filed by residents and their families, they ensure that the resident’s rights are being protected.

The state employs 42 full time long-term ombudsmen.    They are required to visit every licensed assisted living, supportive living and nursing home in the state on a regular basis.

“Every state is required to have long-term care ombudsmen, “ says Sally Petrone.   Ms. Petrone heads the Illinois ombudsman program.   “The program also has 200 volunteers who help the ombudsmen by attending resident council meetings and visiting residents.  The volunteers provide another regular presence in the building,” says Petrone.

Licensed facilities in Illinois are required to keep the contact information for the ombudsman in a prominent place so that residents can see it.    They can also be reached online at www.state.il.us/aging.

According to Petrone, residents or their families filed approximately 5,700 complaints, statewide.   The most common of these complaints were about staffing, service and even disputes between residents and their families.  When they are contacted about more serious complaints that include neglect and abuse, the ombudsmen will contact police and Illinois Department of Public Health.

Families and residents are encouraged to contact the long-term ombudsman even if they aren’t sure whether or not they should.  Most complaints are able to be resolved.