By Amy Jeter

Published: June 12, 2011

Original article: http://hamptonroads.com/2011/06/active-seniors-take-less-time-money-heal

Flat on her back, surrounded by mirrors and workout equipment, Paulette Eschert grimaced in pain.

A physical therapy assistant helped her to roll an orange exercise ball back and forth with her legs. Staples stitched together a long, angry gash on Eschert’s knee.

A 66-year-old Chesapeake resident seeking short-term rehabilitation after joint-replacement surgery, Eschert is the kind of patient Lake Taylor Transitional Care Hospital – and other nursing homes – are seeing more of and are working to attract.

Thomas Orsini, Lake Taylor hospital’s president and CEO, calls them active seniors: “Someone who was active, will remain active, will return to their neighborhood, return to their tennis match, or walking on the beach, or their golf game.”

The growing rehabilitation business is paying off for both patients and nursing homes. Seniors have somewhere to go while they recuperate from a stroke or joint replacement, but they keep their long-term independence. Nursing homes gain from serving more patients with higher-paying health coverage.

“The nursing homes are more and more focusing on the rehab portion of the long-term care business,” said Steve Morrisette, president of the Virginia Health Care Association. “They’re always looking to provide the niche for what people need.”

While the over-65 population grew by nearly 25 percent in Virginia in the past decade, the demand for nursing home beds hasn’t kept pace.

Seniors today stay healthier as they age, delaying the need for long-term care.

Many who need it are determined to live at home – or at least in a homey environment. They’ve opted for assisted-living facilities or in-home care rather than more expensive, more clinical nursing homes.

“Nine out of 10 older Americans want to stay in their home for as long as possible, and most do just that,” said David DeBiasi, associate state director of advocacy for AARP Virginia. “The last desired possibility is a nursing home.”

Usually, seniors who can afford to pay their own way choose the alternatives.

That leaves Medicaid, the state and federal government insurance for people with low incomes, to pay for most nursing-home patients: more than 60 percent in Virginia, according to the American Health Care Association.

In 2010, Virginia’s Medicaid paid $793 million – or 12 percent of its expenditures – to nursing homes for long-term care of the elderly and disabled.

But state legislators haven’t raised Medicaid rates in four years, Morrisette said. Nursing homes lost an average of $8.35 a day per Medicaid patient in 2009, according to the Virginia Health Care Association’s numbers.

Medicare’s rates tend to be higher, averaging $428 a day compared with $147 for Medicaid, according to 2009 Virginia statistics from the American Health Care Association.

One reason is that Medicare pays for more, including intensive therapy and rehabilitation services, while Medicaid is generally footing the bill for chronic-disease care and help with activities of daily life.

However, Medicare, the federal insurance for seniors and the disabled, stops paying for a patient’s nursing home stay after 100 days or earlier if the patient stops showing progress. Medicare patients stay in nursing homes 27 days on average.

“Many facilities are looking to increase their Medicare services and limit their Medicaid for really no other reason than the difference in reimbursement,” Morrisette said.

Nursing homes gradually have been adding short-term rehabilitation services for years – since a change to Medicare’s payment policies encouraged hospitals to discharge patients sooner, said Connie Kane, director of the Virginia Department of Health’s division of long-term care.

“You have a person who doesn’t really have anyplace to go other than home, and they can’t be in the hospital,” Kane said. “So the nursing homes – especially the large corporations – have recognized the need of providing short-term rehab as a service for inpatient nursing home residents or outpatient.”

A $14.6 million nursing home proposed for Virginia Beach’s Princess Anne section highlights its potential rehabilitation program, which includes outpatient services.

A company affiliated with Roanoke-based Medical Facilities of America applied to the state health commissioner in March for permission to build a new 120-bed facility within a mile of the intersection of Princess Anne and Dam Neck roads. Medical Facilities of America is a partner in 32 nursing homes in Virginia, including centers in Chesapeake, Norfolk and Virginia Beach. All the nursing homes and Medical Facilities share a common ownership.

In 2009, Medical Facilities’ Virginia nursing homes provided an estimated $11.3 million in uncompensated care to Medicaid patients, according to the application. The company’s revenue that year was $306 million, and its income was about $18.6 million.

Medical Facilities of America has seen a dramatic increase in the number of patients – usually Medicare recipients – seeking nursing or rehabilitation care for an average of 30 days or less, officials wrote in their application.

The proposed facility would offer a menu of services for long- and short-term residents, including physical, occupational and speech therapy, as well as rehabilitation through Pilates, gardening and using a Nintendo Wii gaming system.

“One of Princess Anne Health and Rehabilitation Center’s main priorities will be to rehabilitate residents and return them to the comforts of their home whenever possible,” the application said.

According to its estimates, Medicare would account for about 44 percent of the center’s net patient revenue by its second year, compared with about 46 percent from Medicaid.

At Sentara Healthcare’s seven nursing homes, Medicare provided about 37 percent of the revenue, even though Medicare patients account for just 15 percent of the facilities’ patient days, said Bruce Robertson, president of Sentara Life Care Corp.

Growing demand for short-term rehabilitation prompted Sentara in recent years to designate wings for such care in two facilities, one in Hampton and another in Virginia Beach, he said. The company is now considering a similar expansion at its other nursing centers, beginning with one off Rosemont Road in Virginia Beach.

Income from rehabilitation services helps offset nursing homes’ losses from Medicaid, Robertson said. “It’s an important part of having the business remain viable.”

At Lake Taylor Transitional Care Hospital, officials decided to expand the rehabilitation program during a four-year, $25 million expansion and renovation of the facility.

The hospital already had enlarged its rehabilitation gym twice before building a new physical therapy wing that can hold 30 to 60 patients. It features private rooms and showers, Wi-Fi Internet service and a separate entrance.

The project includes similar improvements to the facility’s other units, including flat-screen televisions and temperature control for each patient and more space for modern medical equipment. Lake Taylor houses 104 hospital beds, as well as 192 nursing home beds.

Although the hospital’s nursing home operation lost about $380,000 in the fiscal year that ended June 30, Lake Taylor officials hesitated to predict whether the improved rehabilitation department will bring in more money. About 48 percent of the nursing facility’s patient revenue and 30 percent of its patient days come from Medicare.

“It’s really more of a matter of upgrading our product than it was reimbursements,” said Orsini, the hospital’s CEO. “We still need to be viable 5, 10, 20 years from now.”