But because Nightingale primarily cares for Medicaid users, it can't afford to, he said. In fact, Medicaid reimbursement rates are so low, it's costing him upward of $10,000 a month just to keep his in-home health care business afloat.
And so, every chance he gets, Woody travels from his office in Missoula to the state Capitol to speak in support of a proposed program that would increase the reimbursement rate to providers, while requiring health insurance for workers who care for Medicaid patients.
Senate Bill 206, as currently proposed, would insure nearly 2,000 Montanans for about $2.9 million in state funds, which would draw an additional $6 million in matching federal funds, Hanshew explained. The bill, sponsored by Sen. John Cobb, R-Augusta, passed out of committee on Monday and is advancing through the House.
Hanshew is very familiar with the bill. Before becoming director of policy at Montana Health Solutions, he was an administrator in the Montana Department of Health and Human Services' Senior and Long-Term Care Division. After retiring, he was asked to join a study group for the 2003 Legislature and charged with researching ways to redesign Montana's Medicaid program.
The programs he looked at in other states had significant drawbacks, he said. Many of them were complex and politically controversial. It occurred to him that a simpler way to increase the number of insured workers would be to pay health-care providers better and require them to insure their work force.
The proposed Health Insurance for Health Care Workers program is an unconventional solution, Hanshew conceded, but so far it hasn't seen much opposition. Most lawmakers seem to understand that given the increasingly competitive marketplace for health-care workers, most of Montana's employers would offer insurance as a recruitment tool if they could.
“If Medicaid doesn't pay enough, it doesn't happen,” he said.
If this program doesn't work, Woody said, more providers will be forced into their option of last resort - which is to limit the number of Medicaid patients under their care. Already they are turning away potential clients in some locations because they can't find enough workers to care for them.
Six of the state's in-home health care providers have closed in last 18 months, he noted.
When Woody and his brother purchased Nightingale Nursing in 1996, the business focused on private-pay clients, he said. At the time, a number of other providers were closing their doors, so he looked into accepting Medicaid as a way of filling the growing health-care gap.
“Now we are probably 90 percent Medicaid,” Woody said.
Meanwhile, he helped the business grow from a 40-employee endeavor into a top employer with locations in Alaska, Arizona, New Mexico and Nevada. A couple of years ago, the business split into Consumer Direct Personal Care and Nightingale Nursing, both of which are managed by Montana Health Solutions.
“These are all our companies, but we split them up because we wanted people to be able to get to the services they needed directly rather than having to go through all the channels of a large corporation,” he explained.
Providers who deal mostly in private pay have the luxury of setting their own rates, Woody said. They can charge whatever they need to get by, but those who care primarily for Medicaid patients have their rates set for them as a matter of public policy.
In Montana, nearly 110,000 residents eligible for Medicaid received services in fiscal year 2006. That year, the state's total Medicaid expenditures ran to $675 million, only about 68 percent of which was covered by the federal government, said Colleen Noel of Montana Medicaid.
Rates have not kept up with the rising costs of health insurance and the minimum wage, putting providers who accept Medicaid patients at a distinct disadvantage.
“We can't set our prices,” Woody said. “The governor, the Legislature and the Department of Health set our prices, and the prices aren't high enough to pay our caregivers. Health insurance is the most important thing we need.”
Nightingale nursing director Susan Palmer said new employees in Missoula are started at $9.56 an hour and then, within a few months, receive an automatic raise to $9.85. Unfortunately, that's where wages tend to stick.
“We have no room left for health insurance and wage increases,” she said. “It gives us no ability to give them any sort of step increase for long-term employment.”
That makes it hard for Nightingale to compete for workers, Woody said.
“It is particularly bad in Missoula, in Helena, in Great Falls and in Billings,” he said. “The metro areas are worse than the rural, because there's just more people and there's more options for employees.”
DirecTV, for instance, is starting new workers at $9 plus benefits, including full health-care coverage, he noted.
“Within months (of opening), they took 700 to 900 people out of the Missoula work force, and we know because they took some of those jobs from us,” Woody said.
It doesn't help that in-home care is a physically and emotionally demanding service, he added.
“This is a hard job,” he said. “This is people coming in and doing very personal things. You want someone who's just not there for the money. You want people who are really committed to this.”
Unfortunately, the company is currently seeing a 50 percent turnover rate. It's a constant drain on resources just to find replacement staff, Palmer said.
In 2006, Nightingale hired 274 employees - but lost 376, she said, “which means that we end up having to pay a fair amount of overtime for those we still have just to continue to cover our clients' needs.”
Nightingale Nursing currently provides caregiving and nursing services, as well as personal care assistance, to 388 clients. Last year, it cared for more than 500 clients and took on more than 135,000 visits, which can be “anything from 15 minutes up to a 12-hour shift,” Palmer said.
“Some of our clients are people who one day got up and got dressed for work and they went outside and slipped on the ice, and now they're a (quadriplegic) in a wheelchair and they are dependent on Medicaid to keep them alive in their home,” she continued. “That could be you, it could be me, our neighbor, our children.”
While nursing homes are an important piece of the health-care continuum, Woody said, most people would prefer to remain in their homes as long as possible. Also, nursing-home care averages $40,000 a year, while basic in-home care costs an average of $10,000 a year.
“This crosses party lines,” Woody said. “We all know people who need these services. If our goal is to get people off of minimum wage and keep people out of the nursing homes, we have to do this.”
Reporter Tyler Christensen can be reached at 523-5215 or tyler.christensen@lee.net
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