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Hainkel home tussle illustrates populism staying power

Like metastasized cancer, the legacy of populism infects the Louisiana body politic in so many ways, making it difficult for the Gov. Bobby Jindal Administration and reformers to eradicate the disease so interwoven into not just the state’s political culture, but culture in general, as the struggle for the state to exit substantially the nursing home business demonstrates.

Only a few years ago, for the developmentally disabled the state ran several large residential facilities located in various part of the state to warehouse these citizens, paying much more per client than comparable nongovernment providers. Since then, during Jindal’s terms most of these places have been turned into non-residential resources centers, with just one continuing to operate on behalf of clients with the direst of situations of developmental disability. The remainder of former residents either has been placed with nongovernment providers or made the transition to home- and community-based settings.

Yet another outlier exists, because of the political history of the John J. Hainkel, Jr., Home and Rehabilitation Center, or the “Hainkel home.” In 2009, the state wanted to privatize or sell the state-owned facility, as by regulation state operation inflated costs that made the partially-full facility a risky proposition for taxpayers going forward. But the state representative in whose district the place sits, Neil Abramson, successfully sabotaged those efforts.

Next year, Abramson allowed a deal to go into law for leasing, but on terms which included the inflated reimbursement rate and continuous operation of the facility for as long as it had the ability to do so as a nursing home. The state managed to get a deal with the provider named in the bill for a measly $400,000 a year in rent; undoubtedly, it could do much better for the citizenry by disposing of the property or leasing it for some alternative use.

For the fact is, the place is underutilized in an area and state where there continues to be a surplus of nursing home beds, statewide running into the thousands. Further, it has slipped in quality ratings, in part because the state has performed a number of inspections in the past year that found deficiencies. This alone potentially could enable the state to terminate the lease, which would be necessary to halt its operation in order for the property not to have this kind of facility, depending upon the interpretation of the law, as it implies that the property must be operated at a “five star quality” rating (presumably, but not stated in the law, as the “overall” rating).

Instead, the Jindal Administration appears to want to close the facility in its present form through the more sure means of licensing, based upon the deficiencies noted. This has led to accusations of selective enforcement; regardless of whether given the presence of sufficient violations their presence still gives the state the right to revoke the license, but also has resulted in a federal court injunction to make sure the state follows all procedures to the letter before any final decision is made.

However, there is nothing procedurally that can stop the state eventually from yanking the license, so opponents of the move, through a campaign of misinformation, are trying to sway public opinion as a last ditch effort to halt it. Some of it relies upon not telling the whole story, such as the facts that plenty of space exists with other local nongovernment providers, that the home itself is running at only 60 percent capacity, and that it gets that favorable reimbursement rate needlessly costing taxpayers extra.

But some of it is outright falsehoods. The shill that got the injunction claims “no one else wants” these patients, echoed by the author of the news story sympathetic to keeping the place open stating the clients would have “nowhere to go in the city.” Yet the story also presents the tinfoil-hat-wearing claim that the state’s ambition in closure is to shuffle the patients to the only remaining state-owned aging and adult services center Villa Feliciana and collect for itself the (lower) Medicaid reimbursement rate. If so, then how these patients be those “no one else wants” if, according to this black-helicopter-circling scenario, the state wants them badly enough to find a way out of an unfavorable deal?

In reality, few of the Hainkel home patients, if any, probably would end up in the Jackson state home. If area nongovernment providers did not take them – even if the Medicaid reimbursement rates aren’t great at $155 daily (note that this has increased by over a quarter since 2009), Louisiana has providers willing to take them as the typical nursing home in the state derives more than 80 percent of their business from Medicaid with one of the nation’s lowest occupancy rates – likely a number could take advantage of Medicaid waiver programs such as Community Choice so they would not have to live in an institutional setting. Not only does this option provide a healthier environment for many, it also saves taxpayer dollars.

The same shill also whines about how about 135 direct jobs would be “lost,” equating the attempt to save taxpayer dollars with no reduction in the quality of service as “state government at war with its own citizens and trying to create more unemployment” – unapologetically voicing the antediluvian belief that it is a necessary function of government to provide direct citizen employment using its own contract dollars. Would these employees bear the mark of Cain that prevents any other provider from hiring them? Or perhaps some were already superfluous?

The state should bear no obligation to continue operating under an inferior deal and one that may not provide the most appropriate level of care to vulnerable citizens, and it has the right to close deficient operators. But the populist disease makes those enjoying the largesse of government fight such measures because it’s more about them enjoying privilege than it is about the actual clients themselves. And this controversy reminds just how difficult it will be to excise populism from Louisiana body politic.

1 comment:

Anonymous said...

Of course you could just take those folks out and shoot them. That would greatly reduce costs for maintaining them.