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By Alex Roarty, Sentinel Reporter, March 10, 2008

Last updated: Monday, March 10, 2008 11:28 AM EDT

Carson Ritchie struggles to balance the Church of God Home’s budget.

Declining state reimbursements combined with rising costs have forced the North Hanover Street nursing home to raise rates 7 percent each of the past two years.

But if Gov. Ed Rendell’s budget proposal is approved, this year would be worse, says Ritchie, the Church of God Home president and CEO.

The governor proposes no increase in Medicaid funding to nursing homes next fiscal year.

“If they flatline us, I’m not sure people know how they’re going to be able to put together their budget,” Ritchie said.

His concerns are shared by nursing homes across the state. Each is struggling for funding in what the Department of Public Welfare says is a tight budget year, one that won’t give funding increases to anybody within its department.

The governor’s budget turns its back on the elderly, said Ronald Barth. He is the president and CEO of PANPHA, an association of nonprofit services for the aging in Pennsylvania.

“The state, in essence, is saying ‘We don’t care,’” Barth said.

He argued it’s the culmination of several years of neglect.

For the past two years, state government reimbursed Medicaid patients at only 85 percent of the rate it’s supposed to, he said. On average, 65 percent of nursing home patients are on Medicaid.

The number is even higher at the county-owned Claremont Nursing and Rehabilitation Center, according Joanne Wible, administrator at the home.

Seventy-nine percent of its residents are on Medicaid, she said, meaning the home is “heavily dependent” on the state reimbursements.

“This (loss) will lead to increased financial pressure at the local level to support facilities like mine,” she said.

The fallout from the declining state reimbursements will affect everyone, officials say.

In private facilities, Barth said, the costs are passed on, unfairly, to those who can pay with their own money. And Wible added that it could make negotiations with Claremont’s nurse’s union more difficult.

“This safety net is in danger of disappearing within a few years if a concerted effort is not made by the Commonwealth to adequately fund our facilities,” Wible said.

DPW spokeswoman Stacey Whitalec said the threat of a difficult economy means all human services programs, including nursing homes, will not receive a funding increase.

Funding has been tight the past several years, she said, but nursing homes have still received increases when no other programs have.

“We’re concerned about all of the human services programs,” she said.

She added that Pennsylvania spends more on nursing homes than all but one state, and that the daily reimbursement rate for nursing homes has risen 22 percent since Rendell took office in 2003. The state contributed about $760 million toward Medicaid reimbursement last year.

Still, Barth said, the governor’s priorities are misplaced in his budget proposal.

He questioned why roughly $100 million has been allocated for Rendell’s Classrooms for the Future initiative, which seeks to update high school classrooms with modern technology, while a basic service is neglected.

“It comes down to priorities,” he said. “You gotta pay your bills first.”

State Sen. Pat Vance, R-31, agreed. Vance attended an appropriations committee meeting Thursday that discussed the DPW budget.

She said the governor is misappropriating money with his rebate program, which she said unfairly gives money back to those who didn’t pay taxes in the first place.

The money used for the rebates would cover a funding increase for the nursing homes.

“I think the thing that troubles me is that the governor comes up with so many programs,” she said.

Vance added, however, that reductions in federal funding, not just state funding, are also to blame for the department’s budget crunch.

Rendell spokesman Chuck Ardo said the economy and children’s futures are worthy investments.

“Governing is often a matter of making hard choices that leave some people unhappy because we have limited resource,” Ardo said.

Vance said she’s going to try to change Rendell’s mind.

“Can his mind be changed?” she said. “Hopefully — I’m not good at predicting that.”

Ritchie said he’d like to see not only an increase, but back pay to make up for the past several years. The Church of God Home needs it, he said.

The number of people who use nursing homes will increase as the state’s population ages, he said, and those patients are demanding more and more services.

And unfortunately, Ritchie said, many people don’t plan earlier in life to pay for the costs.

“The number of people with long-term insurance,” Ritchie said, “almost doesn’t register on the Richter Scale.”