Trends in Long-Term Care - U.S. Senate Special Committee on Aging

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amount of its renovations, it should not be able to, <strong>in</strong> any sense of the
word, support a debt of $1.3 million.
Senator Moss. Is there any noticeable difference <strong>in</strong> the quality of the
care that is rendered to the patients, as you can see, by reason of this
<strong>in</strong>crease <strong>in</strong> the reimbursement?
Mr. MOAN. Well, my understand<strong>in</strong>g, we first of all have not found
direct correlation. We have not, tak<strong>in</strong>g every nurs<strong>in</strong>g home that we
have, found problems with, transfers with, and checked them for
problems <strong>in</strong> deficiency reports of the city and the State, but what I do
know, for example, that one nurs<strong>in</strong>g home, the Willoughby Nurs<strong>in</strong>g
Home had the reputation of deliver<strong>in</strong>g very bad care, and we had testimony
of such effect before the commission at some of our hear<strong>in</strong>gs.
I also know that some of the other <strong>in</strong>stitutions that we have looked
at, Towers is one, also had atrocious care, so that I know at least <strong>in</strong> isolated
<strong>in</strong>stances, that we have found situations where transfers, a history
of transfers has occurred <strong>in</strong> a build<strong>in</strong>g where there is def<strong>in</strong>itely
bad care be<strong>in</strong>g delivered.
We do not know if one is caus<strong>in</strong>g the effect, however.
Senator Moss. Is there any appreciable difference <strong>in</strong> the reimbursement
rate between, say, 100-bed nurs<strong>in</strong>g homes and 300-bed nurs<strong>in</strong>g
homes?
Mr. MOAN. Yes. The ceil<strong>in</strong>g for all of these th<strong>in</strong>gs was calculated on
an average bed basis, so that if you had a 100-bed, and your reimbursement
rate is $110 per bed, the maximum ceil<strong>in</strong>g, you can get on this
<strong>in</strong>stitution is $110,000.
If you have a 300-bed <strong>in</strong>stitution, it would be $330,000, so that the
ceil<strong>in</strong>gs are calculated accord<strong>in</strong>g to the number of beds; however, the
<strong>in</strong>dividual rents sometimes bear no relation to the number of beds <strong>in</strong> the
<strong>in</strong>stitution.
Senator Moss. The unit reimbursables, the calculation is agreed on
the bed-
Mr. MOAN. That is correct.
Senator Moss. Not putt<strong>in</strong>g nurses' homes <strong>in</strong>to various categories?
Mr. MOAN. That is right. There was a proposal, that was with the
State department of health, to limit future reimbursement to historic
costs, that is to say that an <strong>in</strong>stitution, which was built <strong>in</strong> 1973, for
$500,000, for $1 million, would only be reimbursed on that historic cost,
and not on any of the land transfers that have taken place, and it would
not vary if it had been leased to a third person, or leased to the owner
himself, so all of these th<strong>in</strong>gs have been taken a look at by the State
department of health, as far as I know.
However, they have yet to come down with a formal rul<strong>in</strong>g on that
proposal, so that right now the reimbursement formula is generally
based on the number of beds, rather than a physical exam<strong>in</strong>ation of the
build<strong>in</strong>g, so we may have <strong>in</strong>stitutions receiv<strong>in</strong>g rents that have no relationship
to the real value of the build<strong>in</strong>g itself.
Senator Moss. The department of health could make a decision as
to whether there are too many beds <strong>in</strong> a home, I take it, from your testimony,
about disallow<strong>in</strong>g 53, or some number like that?
Mr. MOAN. Fifty-seven, I believe it was. Yes, they can decertify beds.
My understand<strong>in</strong>g is that the nurs<strong>in</strong>g home that I described, the Willoughby
Nurs<strong>in</strong>g Home, was certified for 210 beds, when there was a
severe bed shortage, and so that they felt it was justifiable at the time