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cliVILars 10111 c. About? effect in the past because in the most common occurrence the “vendor hold” the full amount of funding is restored when the problems are cleared up, resulting in, at most, a cash flow problem for the home. The department may also decertify a home, in which case the Medicaid funding is forfeited for the period the home is in violation, but this happens less frequently. Since last November there has been a third option. New rules were drawn up by the Department of Human Resources, which administers the Medicaid program, that allow DHR to cancel a home’s Medicaid contract after two vendor holds in a twelve-month period. In this case, the funding is also lost for the time the contract is cancelled. The new sanctions are “a whole lot better than the old vendor hold [rules]” says Howard Allen, chief of the Health Department’s bureau of long term care. Under the old process of decertification, hearings were required before action was taken. Action now is “a little more swift,” Allen says. In the year between June 1982 and May of 1983, the Health Department took 167 vendor hold actions and 36 actions toward decertification, according to Allen. In the following year, there have been 417 vendor holds, 66 decertifications, and 42 contract cancellations, he says. “What that should tell us is . . . the people who are getting squeezed are the residents.” Attorney General Mattox “We’re seeing quite a number of facilities on second vendor hold,” Allen says. “And that kind of surprises me.” He is perplexed because in the latter part of 1982 “we saw the level of care not being as good as it was in the past.” As far as conditions in the homes go, it is still too early to tell if the increased enforcement is having much effect, he says. But some Health Department workers doubt it. Patricia Rosendahl, a social worker at the department’s Galveston office since 1977, says, “Nursing homes are just as sorry as they’ve ever been. That’s my observation and I think it’s shared by all of us.” Rosendahl says the nursing homes “have hit some problem areas in the last six months.” A DHR rule which was intended to protect patient rights has ended up giving administrators less control over discharging patients who endanger oth ers, she says. “There are some heavy, heavy psych patients in nursing homes,” she says. “We’ve always taken some, but the thing is, we used to be able to select and keep the violent ones out.” Rosendahl pointed to the August 5 killing of an elderly patient in a Brookshire home by a mentally disturbed patient. “It is a thousand percent easier for a patient like that to get into a nursing home than a state hospital,” she says. Although she didn’t, at first, expect the new Medicaid sanctions to have much effect, Rosendahl says “there’s more teeth to it than it appeared. It is hurting, them [the homes] financially.” The problem is, it doesn’t seem to translate into better patient care, she says. Most of the Health Department standards seem to relate to physical defects and paperwork. “It is easier to fix all those other things than to keep an eye on day-to-day care,” she says. Rosendahl would advocate a statemandated nursing staff-to-patient ratio if she weren’t afraid the legislature would set the standard too low and make things worse. The shortage of nursing aides is “the real breakdown of the system,” she says. /N THE LAST session of the legislature, Sen. Lloyd Doggett, DAustin, carried legislation drafted by Mattox’s office which would have, among other things, created a system of fines to strengthen Health Department enforcement of standards. The legislation passed the senate but died in the last days of the session, as the nursing home lobby worked frenetically against it, and the house and senate were unable to reach agreement. Now the Attorney General’s office is again preparing a statute to propose to the next session of the legislature. Charles Yett, director of the Medicaid Fraud Unit of the AG’s office, says there are no state laws which cover many abuses of the Medicaid system, such as billing patients for services and then collecting from Medicaid for the same services. “It happens, and I think it happens with some frequency,” Yett says. Yett believes the legislature should establish criminal penalties for such abuses. Mattox will be pushing for a system of liquidated damages cash fines to “hit these people where they think, and that’s in their pocketbook.” “What I mean is, if a person does not provide the proper number of employees on the job, does not provide the right kind of food or other type of care, then we believe there should be what we call liquidated damages, where the nursing home knows how much it’s going to cost them if they don’t provide the proper kind of care.” Health Commissioner Bernstein opposed such a plan the last time around, saying it would be “so hard to administer.” Such a plan also is not favored by the Texas Health Care Association \(formerly the Texas Nursing Home industry. “We’ve got plain plenty of law and plenty of enforcement,” says Pat Cain, a consultant to THCA. The nursing home lobby is likely to push for more money from the Medicaid program. The rate is set at $29 per patient per day, which the industry claims is not enough to upgrade care. Mattox agrees, even though he admits the industry tends to have “real healthy profits.” “What that should tell us is, if they’re being paid this little and they still have healthy profits, it means that the people who are getting squeezed are the residents.” But the one thing that seems most likely to result in a shake-up of the nursing homes in Texas is another scandal. Patricia Rosendahl, who says she has wanted to get out of nursing home social work ever since the Autumn Hills case, worked her last day this August. She says it’s not hard for her to imagine another case like Autumn Hills. “Autumn Hills has happened before, many, many times. It kind of came and went, and so what?” she says. The neglect and abuse that she saw there over the years “goes on constantly,” even today. “The question is, who notices and pays attention?” Parisian Charm. Omelette & Champagne Breakfast. Beautiful Crepes. Afternoon Cocktails. Gallant Waiters. Delicious Quiche. Evening Romance. Continental Steaks. Mysterious Women. Famous Pastries. Cognac & Midnight Rendezvous. In short, it’s about everything a great European style restaurant is all about. he Old St Cafe 310 East 6th St. Austin, Texas THE TEXAS OBSERVER 7