What do Veterans, specifically those at the Vermont Veterans Home and Vermonters with Alzheimer’s, especially those seeking help to get into a care setting, have to do with each other? In a word, plenty, but before I explain how let me help set the stage briefly for this topic.
Every day when legislators arrive in the coat room at the State House and check their mail boxes they are flooded with invitations and announcements from various groups to join them for coffee, treats or just conversations that they are sponsoring in the State House or around Montpelier. The range of invitations is huge running from the Chamber of Commerce, dentists, optometrists, anti-hunger groups, ambulance drivers, veterinarians, contractors, you get the picture. The list is endless. You could spend your day drinking free coffee and eating donuts, or an assortment of appetizers, which while I do enjoy the coffee I fight the treats, sometimes unsuccessfully, but I digress.
So, recently in my mail box, which I usually rifle through and recycle, I was caught short by an invitation to join some Vermonters to recognize Alzheimer Advocacy Day. I held the note for some time and thought hard about those over the years I have known first hand as a friend and as a former Nursing Home Administrator for 16 years who have struggled and succumbed to this horrible disease. I thought of the heavy toll extracted from their family members. I asked myself what I could do. Surely Vermont will not find a cure, other scientists may on the national level, but what could I do to help even in a small way for those who live the Alzheimer’s journey.
Later that week I recalled that the Vermont Veterans Home was caught in a financial pickle because many of their patients with dementia related illness scored low on the payment system used to compensate nursing homes. There are over 40 different payment classes that a patient may be categorized into which in turn results in a score, which when averaged together translates into to a daily payment rate for each nursing home.
When the payment system was designed by the Research Triangle Institute in the 1980’s they never accurately considered behavioral needs, but used a patient’s capacity to do what we call activities of daily living to drive the reimbursement. A patient who could not bathe, dress, feed or toilet themselves scored many points. A patient who wandered about fretting, unintentionally disturbing other residents and requiring much time to help settle and comfort, scored very low.
To help remedy this situation and help a growing number of older Vermonters with extreme behavioral challenges who are ending up in our hospitals inappropriately, the House Appropriations Committee has included in the budget bill a requirement that the State of Vermont will adjust the patient payment system to properly score the time and cost necessary to serve patients with dementia who still can do their physical care with moderate assistance. This change will encourage Nursing Homes to admit more patients with Alzheimer’s or psychiatric needs.
Now, back to the Veteran’s Home. Our hope is that by paying the Veterans Home properly for dementia patients it will increase their Medicaid payment rates. Today, the cost to cover the care at the Veterans Home to make up for the outdated payment system falls solely on the backs of Vermonters in the amount of $6 million per year. When we increase the Medicaid payments, the federal government and not solely Vermont taxpayers, will help share the cost. The savings from this change can free up the state dollars to help pay all nursing homes a better rate for dementia related care. This will help families who have a loved one with Alzheimer’s access the security of a 24 hour a day setting when necessary.
Admittedly this is no way helps a family reconcile why they and their loved one has to endure this disease. It will not change the fact that Alzheimer’s is the 5th leading cause of death in Vermont. Their troubles and pain will sadly go on. But, it will help a segment of the 12,000 Vermonters with Alzheimer’s do better than they are today. I sure wish there was more that I could do.