The long term care industry in this state continues to face significant hardships which impact Missouri's elderly. The increased cost of care, the inability of medicaid to keep pace with those costs, and the lack of qualified and competent staffing is affecting the quality of care. The committee looked at a number of factors which are believed to be the causes of these problems and develop the following recommendations:

Inconsistent Surveys: Facilities in different areas may not be cited for the same deficiencies.
* The Department of Health and Senior Services (DHSS)should provide appropriate training and oversight to assure fair and consistent application of rules and regulations.
Inspections: Mandatory inspections tie up inspection staffs.
* Facilities with no Level 1 citations or little or no deficiencies be surveyed once a year.
Informal Dispute Resolutions: The IDS process is unfair and needs revision.
* DHSS implement rule changes to make the process objective, fair, and reasonable.
Medicaid Funding: Medicaid reimbursement is based on 1992 figures of cost of care.
* Payments plan should address patient care, ancillary services, administrative and capital costs.
Rebase annually, costs vary between facilities. Rate review when facilities change hands.
Certified Nurse Assistant: Turnover impacts quality of care.
* DHSS needs to design plans to implement career development programs for CNA's.
Promoting the Nursing Profession: The need for professionals in the field of geriatrics.
* DHSS needs to develop grant programs, establish fast track scholarships, loan repayment programs, and develop internship programs for long term specialty care areas.
Certificate of Need: CON and the moratorium needs to be studied independently.
Non-Emergency Transfers: Non-emergency transfers are not covered by medicaid.
* Not reimbursing for non-emergency transfers places a great financial burden on facilities and impacts quality of care. Many clients do not receive the care they need because they are not being transported to hospitals and treatment centers.
Baby Boomers: People are living longer and long term care facilities are providing services for persons generally over the age of 85.
* DHSS needs to develop long term strategies to deal with the influx of baby boomers that will be coming into the system in the future.
Olmstead Act: Provides home and community based services to persons who would otherwise be intitled to institutional services.
* Introduction of legislation to implement portions of the Olmstead Act.
Bed Tax: The bed tax affects the facilities because they are taxed on non-medicaid beds.
* DHSS needs to develop better alternatives to maximize the state's medicaid draw down of federal funds.

Bob Dominique, Legislative Analyst