Dilliner Jordan works 62 hours a week taking care of two people who are too medically fragile to take care of themselves. But she has no health insurance and often sleeps in her car because she can’t afford rent and a security deposit, even though she has been saving for months. She is fearful of staying at a shelter, which she believes will increase her chances of contracting COVID-19 for a second time. “It does bother me,” the 63-year-old Brooklyn, N.Y., native said. “It bothers me a lot.
While the deadly coronavirus seems to be subsiding in Connecticut for now, its impact on nursing homes has not. More than 6,700 beds are empty, and it may take many months of financial struggle before occupancy climbs back to pre-pandemic levels. Of the approximately 200 nursing homes in Connecticut that receive payments from Medicaid, the government health insurance program for low-income people, only 15 were 70% or less occupied in January, according to the Connecticut Health Investigative Team’s analysis of state data. By August, almost five times as many facilities saw occupancy drop to that level or less. While the statewide average decline was 15%, the number of residents in 19 nursing homes has plummeted to 55% and below since January.
State investigations of elder abuse, ranging from neglect to emotional abuse to physical abuse, more than doubled in Connecticut between 2011 and 2017, from 3,529 to 7,196. In 2017 alone, the state Department of Social Services (DSS) received 11,123 reports of elder abuse and decided that 7,196 warranted an investigation. That year, self-neglect—when adults are unable to provide for their own basic care—was the most common type of elder abuse reported to DSS, at 30 percent, followed by neglect by others, financial exploitation, emotional abuse, physical abuse, sexual abuse and abandonment. “It’s all trending up,” Dorian Long, DSS director of social work services, said. Some of the recent cases investigated by DSS Protective Services for the Elderly are chilling.
Since 2011, Connecticut has issued more than 39,000 new Medicaid cards to prisoners returning to communities, connecting them to health care services with the goal of keeping them healthy and out of prison. This initiative, which gives ex-offenders the opportunity to see a primary care physician on a regular basis and access critical mental health and drug-abuse treatment programs, exists because of the Affordable Care Act (ACA), and Medicaid pays most of the costs. Recidivism data show that the initiative is working, state officials say. Yearly, the Court Support Services Division (CSSD) refers approximately 20,000 adults on probation to various behavioral health programs and tracks them for 12 months. In 2016, CSSD reported that 23.1 percent of adults who completed their referral program were rearrested, a five-year low since CSSD started tracking in 2012.
Health insurance coverage might be more accessible and affordable in Connecticut if the state applied for certain Affordable Care Act and Medicaid waivers, according to advocates who say the options should be explored. Two waivers in particular—Affordable Care Act (ACA) Section 1332 and Medicaid Section 1115—would let the state disregard certain federal requirements, possibly lowering health care costs for some individuals, according to a policy brief commissioned by the Universal Health Care Foundation of Connecticut and the Connecticut Health Foundation. “What we need to do in Connecticut is really think about … how could we creatively, imaginatively, innovatively use waivers to expand coverage to quality care and really help improve health,” said Frances Padilla, president of Meriden-based Universal Health Care Foundation of Connecticut. “We haven’t had that conversation yet in Connecticut.”
The ACA waiver isn’t available until 2017 but the Medicaid waiver is already being used by dozens of other states to lower costs, she said. “It allows a state to get past some of the requirements of Medicaid and do some things that are innovative,” she said of the Medicaid waiver.
The state has barred practitioners at a Derby pain clinic, including a high-prescribing nurse, from participating in the Medicaid program because of improprieties in treatment and oversight. Documents from the Department of Social Services (DSS) show the physician heading the clinic, Dr. Mark Thimineur, and four nurses and assistants were notified in July that their participation in the Connecticut Medical Assistance Program, which includes Medicaid, is being terminated on Aug. 30. Those terminations came after Heather Alfonso, an advanced practice registered nurse (APRN) at the privately run Comprehensive Pain & Headache Treatment Centers, was removed from the Medicaid program in May, DSS officials said. Alfonso was identified in a February story by C-HIT as among the top 10 prescribers nationally of the most potent controlled substances in Medicare’s drug program in 2012 — Schedule II drugs, which have a high potential for addiction and abuse.
Allowing the spouse of a person in a nursing home to keep enough money to live on independently is, in many ways, a moral issue. But in a tight budget year in Connecticut, it’s a fiscal issue. A proposal that would increase the minimum assets that a spouse living in the community can keep — from $23,844 to $50,000 – in order for his or her partner to be eligible for Medicaid nursing home care is being backed by elder advocates, who say the increase would help seniors, especially women, remain able to live independently. But the move is being opposed by the Department of Social Services on the grounds it will shift millions in costs to the state-funded Medicaid program. The proposal would affect couples with combined assets of between $23,844 and $100,000.
Patient-centered medical homes are designed to improve health care quality while lowering costs, but advocates also want to make sure that the new primary care model tackles another issue – health equality.
Governors in some of the states with the highest rate of uninsured people – including Louisiana, Texas, and Florida – insist they’ll opt out of the Medicaid expansion offered under the Affordable Care Act – or Obamacare. One political website (Politico.com) calls them the “hell-no” states.
Multi-million dollar initiatives to help at-risk and parenting teens across Connecticut call for “evidence-based” and “culturally appropriate” approaches – the mantra of experts assisting Hispanic youth, who have the highest number of teen births in the state.