A union representing nursing home workers in Pennsylvania has accused the industry of shortchanging patients and workers by underfunding direct care and by inadequate wages and staffing.
The SEIU Healthcare Pennsylvania study - which doesn't include county, hospital-based or rehabilitation homes - alleges that even as nursing homes complain about a shortage of funding from Medicaid, many fail to devote a full measure of those Medicaid payments to direct care.
Many homes also undermine care through low wages and understaffing, making life harder for patients and workers - even as the homes collect high profits, according to the union.
An industry association excoriated the study as badly flawed, designed mainly to give the union more leverage in ongoing contract negotiations.
State nursing homes made $500 million in profit last year, according to the union. Yet 30 percent failed to spend as much as 95 percent of their Medicaid funding intended for direct resident care on direct resident care, a union news release stated.
That finding is based on a comparison of "the resident care [reimbursement] component of the Medicaid rate ... to the resident care spending component," according to an email from union spokeswoman Amelia Abromaitis.
The Pennsylvania Health Care Association contests the union findings.
The "SEIU misused and distorted the facts," according to an emailed statement to the Mirror under the name of Stuart Shapiro, association CEO.
The union itself states that the findings take account only of spending and reimbursement in the direct care residential category and ignores the figures in three others: resident-related, which includes dietary, housekeeping and activities; administrative, which comprises business office functions; and capital, which includes building and grounds.
All those reimbursements together theoretically cover all costs of caring for Medicaid patients, with adjustments for homes based on number and acuity of patients and location.
Union researcher Dennis Short justified limiting the scope of the investigation, saying, "We tried to compare apples to apples."
The union also didn't take into account the state's "budget adjustment factor," which reduces all homes' actual reimbursements in proportion to the state's overall Medicaid funding shortfall.
If the union had used the lesser actual amounts received by homes as a basis for comparison with the amounts those homes spent on direct care, some of the 30 percent of homes tagged as having shortchanged direct care wouldn't have been tagged, Short conceded.
In contrast to the union, the association stresses the Medicaid shortfall.
"Pennsylvania pays an average of $26.26 less per Medicaid resident per day than the actual cost of care," the association stated. "That means a nursing home spends an average of $9,500 more a year caring for each Medicaid resident than they will receive in reimbursement."
That shortfall is eroding services, because "in order to continue to provide access to needed services for elderly residents on Medicaid, nursing homes have had no choice but to reduce their staff, reduce or freeze wages/benefits, shelve much-needed renovations and end or delay programs that enhance residents' quality of life."
Medicaid pays for 62 percent of Pennsylvania nursing home resident care, according to the union.
Recently, cuts in Medicare have exacerbated the problem, because homes can't use it as well to subsidize Medicaid losses, according to the association.
Despite what the union says, nursing homes are not highly profitable, according to the association.
"Profit margins hover around 1 percent [nationally] and are by far the lowest of any health care sector and getting smaller every day," the association stated.
A pair of certified nursing assistants who participated in a conference call several days ago spoke of the pressure they're under to complete rounds when other workers don't show up - pressure that results in worse care for residents.
A good day is when she has 10 residents to wash, dress and take to the dining room, said Yeta Okoth of Harrisburg.
A bad day is when there are 15, which means she "better be organized," she said. There's not much time for friendly conversation or gossip on those days.
"People say I'm doing God's work, and I don't disagree," said Wanda King of Lancaster. "But that shouldn't mean I have to live in poverty or work so many hours that I neglect my family."
Currently, 7,000 nursing home workers are bargaining for new contracts, according to the union.
"There is a time and place for labor/management discussions, but it is not in the public forum using trumped up numbers and arguments," the association stated.
Three bills have been introduced to implement recommendations in the union report.
Senate Bill 624, sponsored by Sen. Sean Wiley, D-Erie, would require nursing homes to meet a minimum level of certified nursing assistant staffing.
Senate bills 625 and 626 would require nursing homes to report turnover and staffing levels to the Department of Health and require homes to spend a minimum amount of Medicaid resident care per diem rate.
Mirror Staff Writer William Kibler is at 949-7038.