BUSH MEDICARE CUTS WOULD DECIMATE NURSING HOMES, CRITICS SAY.

Byline: Bill Hillburg Washington Bureau

Thousands of ailing California senior citizens and their caregivers could be pushed over the edge by looming cuts in Medicare payments to nursing homes, an industry group said Monday.

A study compiled by the American Health Care Association found that per-patient Medicare payments to California nursing homes would decline 18 percent, from $450 to $379 a day, under the 2002-03 federal budget proposed by President George W. Bush.

The cuts, which could take effect Oct. 1, have been branded by opponents as the ``Medicare cliff.''

``It's our mothers and grandmothers who will be going over that cliff,'' Dr. Charles Roadman, AHCA president, said during a media briefing at the National Press Club.

He predicted the cuts will lead to shortages of nurses and other staffers, diminished patient services and even bankruptcies that could lead to the shutdown of nursing facilities.

Bush has proposed a $3 billion cut in Medicare payments to nursing homes, including $241 million to California's 1,160 skilled-care facilities, with the money going instead to homeland defense and the war on terror.

He also wants to streamline the Medicare program and has argued that private-sector competition will improve care for the elderly.

Rep. Elton Gallegly, R-Oxnard, dismissed the AHCA report as ``another case of playing with numbers by a special-interest group.''

He noted that the Republican-controlled House recently passed a budget resolution that includes a 3 percent overall increase in Medicare spending.

Gallegly said he supports Bush's efforts to streamline Medicare and eliminate fraud, predicting that the moves will result in improved care for seniors.

``We have to address the issues of fraud and abuse,'' he added. ``It's the taxpayers who are paying for these programs.''

Lauri Costa, a consultant for the California Association of Homes and Services for the Aging, a Sacramento-based lobby for the state's nursing homes, predicted that the cuts would harm health care.

``We already have a shortage of 45,000 skilled-care nurses in our homes and any cuts will further hurt our ability to hire and retain professionals,'' she said.

Costa also said a decline in Medicare benefits could result in a shortage of beds for elderly patients, most of whom come to skilled-care nursing homes after receiving emergency or acute care at hospitals.

``Nursing homes are going to have to look hard at who they can afford to accept,'' she said. ``They may have to turn away people who need expensive types of care.''

An estimated 12 percent of the nation's elderly nursing home patients are poor and depend entirely on Medicare, the federal medical program for those age 65 and over. Other patients receive limited Medicare benefits, based on their financial resources.

Roadman said nursing home program cuts could have a ripple effect on hospitals, which also face financial pressure. ``If there are no nursing home spaces, many of the very ill elderly would have to stay in hospitals, where the costs of care can average $1,800 per day and compensation by Medicare is also limited, he said.

Nursing homes advocates fear a replay of their 1997 financial crisis, which erupted after Congress made deep cuts in Medicare to balance the federal budget. An estimated 3,000 nursing homes nationwide declared bankruptcy within a year, leading Congress to shore up Medicare with supplemental funding that would be eliminated under the Bush budget plan.