According to the most recent Iowa Health Care Association Bulletin, Governor Culver is continuing his efforts to implement the 10 percent cuts he announced earlier. Bill Burch, owner of The Continental Care Center at Seymour, Inc. ( ), commented on the impact to rural communities and the seniors who live there. "Members of state government continue to disconnect themselves from their rural roots and from common sense. To add insult to injury, the lower the occupancy, the lower the patient per day reimbursement." Burch is correct. The IHCA bulletin states, "Those nursing facilities with occupancy rates below 90 percent will see the highest cuts." Burch states, "Something is backwards. Our representatives tell us either they did not endorse this formula to determine reimbursement or if they did endorse Governor Culver’s idea, they say it was part of a much more complex package. Subscribing to the formula "the lower the occupancy, the lower the per-patient-per-day reimbursement" shows a distinct lack of common sense, and it gives the impression that the State of Iowa believes that smaller nursing homes which face occupancy challenges should be forced out of business"

Currently, skilled care communities are penalized when their occupancies drop below 85%. Little is reported concerning the impact of Medicaid payment systems.
The State of Iowa is facing numerous challenges. Many of us are very concerned by what we consider a too simplistic approach to budget management. Although opinions do vary, some believe that flat- across-the-board reductions are good for the system. However, those of us who are actually involved in the day-to-day operations of these health care facilities argue that not all areas of state spending are of equal importance. Only time will tell what the State of Iowa will finally do.

Burch is not hopeful that our state representatives will realize the negative effects on the smaller health care facilities should these reductions be implemented. "It has been the longstanding practice of politicians to redirect financial burdens to employers; that includes the poor, small rural skilled care providers like those in communities similar to Seymour and Centerville, Iowa. Those of us who are "in the trenches" are finding it very difficult to swallow the proposed changes. Medicaid requires complete disclosure of finances, then dictates the reimbursement based not only on the residents’ financial statements, but also the facility occupancy. It is a spiraling death fall. Rural communities are both challenged and shrinking. The nursing home occupancy rates drop because of the decline in population. The state acknowledges this, yet still reduces the per-patient-per-day reimbursement when occupancy rates decline. Because of the reduced reimbursements, nursing homes are forced to find ways to cut costs. Unfortunately, as a result of these budget cuts, a nursing home may lose some visual appeal, further impacting occupancy and so it goes. The attention is then redirected to the nursing homes, residents’ families read the newspapers, and since someone has to be at fault for the reduction of services to their mothers, the obvious scapegoat is the nursing home!

What can we do to help the legislators understand how seriously these budget cuts are affecting the residents of the smaller nursing homes? Few agree on a particular plan; however, most to agree that simplistic cuts are not representative of strong leadership.