E.V. patients, providers fear cuts to home care

Life for Edna Bonham changed forever three years ago, when she stood up from her bedside to get on her wheelchair and heard her ankle pop. The ankle broke, forcing Bonham, who suffers from severe osteoporosis, to become bedridden.

“And things went downhill from there,” said Bonham, 65, who lives near Queen Creek. Both she and her husband suffer from cerebral palsy. 

If not for a battery of home care service providers, who help change her catheter and turn her every two hours at night to lessen the pain of bed sores, Bonham said she couldn’t imagine how she’d get by.

“If I didn’t have all these things, my life would be over,” Bonham said. 

That’s also why Bonham is concerned about the national health care reform bill and the cuts being debated in Washington D.C., and how those might impact her access to home treatment. 

Local health care providers are lobbying in Washington, fighting what they describe as disproportionate cuts in the bill to Medicare’s home health services benefit, which could affect an untold number of Arizonans who rely on the funding to pay for such care.

Banner Home Care and Hospice chief executive David Baker said home health care accounts for about 3.5 percent of the Medicare budget, but it faces more than 10 percent of the cuts in the House health care bill and nearly 10 percent in the Senate bill.

The total bill is expected to cost about $800 billion to $1 trillion over 10 years. The Senate has yet to take a final vote on its version. If it passes there, the two chambers would have to resolve differences in the bills before one can be sent to President Barack Obama.

Baker, who’s part of a small group of industry leaders working in Washington to help stave off cuts, said the lobbyists understand they’d have to shoulder some burden, “but we only want to pay a fair share.”

“We’re talking about home care agencies across the country, including here in Arizona, who will be in a negative financial situation, operating on a loss,” Baker said. “We’re looking at less dollars to provide needed services to the community.” 

Bonham pays her bills using a combination of federal and state health care funding programs.

The cuts are going to directly affect home health agencies’ ability to provide services to patients who are now able to stay home and get treatment, Baker added.

The House version had cuts to the home care industry of about $54 billion over the next 10 years. His group is working to bring the Senate one down to about $34 billion to $37 billion. 

Banner is the largest home care agency in Arizona, serving 12,000 new patients every year. There are 70 Medicare-certified Home Health Agencies in Maricopa County. 

“If there are huge federal cuts, it would shake up my life — I would really be in jeopardy,” said Bonham, who was laid off from work at a group home agency five years ago.

Baker said services would have to squeeze costs down and work on a tight budget.

For Bonham, the concern is what any major cuts would do to the quality of service. 

“If there’s a shortage of personnel and they’re trying to spread themselves over the same amount of consumers, that can create a problem of quality, because you’re going to get less time for each patient, perhaps,” Bonham said. 

Janice Crossan, director of patient care services at Heritage Home Healthcare, which serves about 400 Valley residents, said that without a specific amount known, it’s hard to say exactly how much of an impact the cuts would have.

“We’re being expected to provide more services, but we’ll have less money to do so,” Crossan said. She said Medicare represents 70 percent of the agency’s budget because of the high number of Medicare patients. The cuts could mean laying off workers. 

“It’s going to be very hard,” Crossan said.  

Mesa resident Betty Rose Gaines, 68, had to use home care service for the first time this month following a knee replacement. She said it would have been much harder for her to have to go to a hospital for physical therapy.

“Even trying to bend my leg to get in the car was not easy,” Gaines said.

If not for the physical therapist who helped her bend, lift and stretch her knee toward recovery at home, she believes she would not have made progress as quickly as she did. She also saved money.

“Had I gone to Banner for physical therapy, it would have cost more in the long run, for facility charges and whatnot,” said Gaines, who’s on a Medicare Advantage plan.

A spokesman for U.S. Rep. Harry Mitchell, D-Ariz., who voted in favor of the House version, said Mitchell believes home care is important and provides valuable services. 

“When the Congressman voted for the bill, one of the things he said was the bill isn’t perfect and he does have some concerns with it, but he voted on it to move it forward, hoping it would be improved in the Senate,” said spokesman Adam Bozzi. “If he had voted against it, it wouldn’t have made any headway at all.”