[NJblue]

The basis for the original law seems to fly in the face of the laws of supply and demand. Perhaps someone can come up with an example of a situation whereby supply is restricted by fiat and the result was lower price, but I can't. It would seem to me that this law has the opposite effect of lowering costs by artificially restricting the supply and thus driving the price up.

An argument could then be made that Morse should try to reverse the entire law. However, perhaps the politics to do so are too much to overcome and instead he chooses the simpler path of addressing the needs of his community. Regardless of how it is accomplished, it seems like a positive thing for those of us who may benefit.

As to the media coverage of this, I wish they would spend an equal amount of ink on questioning the premise of the original law. It would be interesting to see who was behind its original inception. My guess is that those who currently owned nursing homes were putting money into its passage since it is a way to minimize competition. Wouldn't it be great to operate in an environment that virtually guarantees you 96% occupancy? Wouldn't the hotel industry love a law like this?

[blueash]

Originally Posted by graciegirl

Could you further explain this part? Is this kind of like public housing?

The rationale for Florida attempting to control nursing home cost is this:
"Medicaid is the primary payer of nursing home care in
Florida, paying for 61% of total nursing home patient days. Medicare pays for 19% of nursing
home patient days and the remaining 20% is paid for through private sources such as
insurance or residents’ personal funds. At 80% government funding, nursing homes are
heavily subsidized and dependent upon state and federal funds for operation."

Here is the specific law and "reasoning" by statute
"408.0435 Moratorium on nursing home certificates of need.—
(1) Notwithstanding the establishment of need as provided for in this chapter, a certificate of need for additional community nursing home beds may not be approved by the agency until Medicaid managed care is implemented statewide pursuant to ss. 409.961-409.985 or October 1, 2016, whichever is earlier.

(2) The Legislature finds that the continued growth in the Medicaid budget for nursing home care has constrained the ability of the state to meet the needs of its elderly residents through the use of less restrictive and less institutional methods of long-term care. It is therefore the intent of the Legislature to limit the increase in Medicaid nursing home expenditures in order to provide funds to invest in long-term care that is community-based and provides supportive services in a manner that is both more cost-effective and more in keeping with the wishes of the elderly residents of this state."

I leave it to each person's interpretation whether this law is really "in keeping with the wishes of the elderly" or really more motivated by wanting to force the poor in "managed" Medicaid (read private insurance taking a portion of the health care dollars and limiting patient access to produce a corporate profit). Bold typeface is mine and not in the original.

[jimbo2012]

ooouch!!!!

I didn't write any of it, just straight from the papers.

Originally Posted by graciegirl

Read carefully. Jimbo is quoting several things, but it isn't clear.

THE first part is a quote from The Tampa Bay Times and it has a political slant to it.

Jimbo ended up making the post fair...but I had to reread it several times.


I was about to go over and kick him in his bad leg.

[blueash]

Originally Posted by NJblue

The basis for the original law seems to fly in the face of the laws of supply and demand. Perhaps someone can come up with an example of a situation whereby supply is restricted by fiat and the result was lower price, but I can't. It would seem to me that this law has the opposite effect of lowering costs by artificially restricting the supply and thus driving the price up.

I am not qualified to answer that good question. But if the supply greatly exceeds the demand and the government pays 80% of the cost, would it not be reasonable to try to use the supply efficiently? Doesn't Walmart keep costs down by not having excess inventory? (Beds are inventory for a hospital or nursing home) Would you see the logic of filling the jail cells we already have before we build more jails? Would you as a taxpayer support a law that says no new jails until the ones we have are filled to 96% capacity? I don't want anyone thinking I am comparing nursing home residents to inmates, but the likelihood of controlling supply can easily been seen to lower cost. Would you build a new hotel if the hotels in the area all have lots of empty beds? Keep in mind there is no provision for "we are going to build a nicer hotel." The legislature does not see the supply as restricted with existing empty beds just expensive as it is paying for those empty beds.

[gpirate]

What about Asst Living in The Villages? Does TV have one? I would think many as they grow older would prefer an Asst Living facility and then moved to nursing home when needed. Just my 2 cents worth.

[NJblue]

Originally Posted by blueash

I am not qualified to answer that good question. But if the supply greatly exceeds the demand and the government pays 80% of the cost, would it not be reasonable to try to use the supply efficiently? Doesn't Walmart keep costs down by not having excess inventory? (Beds are inventory for a hospital or nursing home) Would you see the logic of filling the jail cells we already have before we build more jails? Would you as a taxpayer support a law that says no new jails until the ones we have are filled to 96% capacity? I don't want anyone thinking I am comparing nursing home residents to inmates, but the likelihood of controlling supply can easily been seen to lower cost. Would you build a new hotel if the hotels in the area all have lots of empty beds? Keep in mind there is no provision for "we are going to build a nicer hotel." The legislature does not see the supply as restricted with existing empty beds just expensive as it is paying for those empty beds.

Yes, Walmart does do this because they operate under the law of supply and demand versus government dictate. Can you imagine the price of toothpaste if the government said that stores would not be allowed to stock more than 50 tubes at a time?

The hotel analogy is precisely my point. Why does the government need to get involved with restricting beds when the laws of supply and demand already would do that? Just as a potential hotel owner may think twice about opening a new hotel if the occupancy rate in existing hotels is low, a potential nursing home owner would look at local occupancy rates before deciding to build.

The jail analogy is apples and oranges since jails do not operate under laws of supply and demand since they are government run and hence are a monopoly. However, in some areas there are privately run jails and I'm sure that these private operators do look at occupancy rates before deciding to build.

[JourneyOfLife]

Originally Posted by blueash

---
If the home has empty beds the cost per resident is obviously higher, and that cost is passed to the taxpayer.
---

Several states have put a moratorium on Nursing Home capacity (limit the building of new facilities) in an attempt to control Medicaid Cost.

But I do not think it works like that. IOW I doubt Medicaid will cover a NH loss due to vacancies.

I think it is more likely to be: Fewer Medicaid beds, means fewer people relying on Medicaid will be admitted at a given point in time. Medicaid recipients may end up on a waiting list. I look at it as a form of rationing without refusing payment.

Nursing homes prefer private pay patients because the reimbursement rate is higher.

In many states, nursing homes only allow a fraction of their bed to be eligible for Medicare and Medicaid patients. I am sure the state can influence the number somewhat. But they would stop short of saying open it all up. That would probably just cause many of them shutdown.

I think nursing homes shoot for an average reimbursement rate (mix of payers) that gives them the best profit margin balanced by whatever the state and federal rules require.

[justjim]

Does TV need more nursing home beds? The answer would seem to be YES. Even a casual observation of our population and the number of nursing homes available, one would easily come to the conclusion of a GREAT need for more nursing home beds in TV.

[Harry Gilbert]

Originally Posted by justjim

Does TV need more nursing home beds? The answer would seem to be YES. Even a casual observation of our population and the number of nursing homes available, one would easily come to the conclusion of a GREAT need for more nursing home beds in TV.

The only way to qualify your statement would be to know if and how large a waiting list is to get into the presently operating nursing facilities.

I am not familiar with the facilities there but am somewhat with those in NJ. I can say that those that are mainly govt subsidized (medicare, medicaid, welfare ) are not places that I would send any of my family to. Now those that cater to the wealthy elderly are quite a different story. These are mostly out of pocket and run 10K per month and up. I'm guessing that any new facilities in TV would be self pay? Business wise it makes perfect sense. Kind of a back door way to get it built though

[golf2140]

Originally Posted by skip0358

So what. If the Bill gets passed good for him. How many other facilities in TV are age related? Two more that I know of are planned for 466A, one is going up on Parr Drive, tha Hospital if it happens may be going up by Brownwood, there's an extension planned for Freedom Point, etc. People moved here to retire and spend the rest of their lives here, and a good majority will be buried here. TV puts a ton back into the county coffers and if they get it passed AMEN for them. More jobs will be created and a spouse or family member will be closer to loved ones.. JMO

[Bogie Shooter]

Gov Scott will take money from anybody for anything....just happens this is for a nursing home. Last year he was against having volunteers visiting nursing homes looking for poor conditions. Go figure. All political.

[janmcn]

Originally Posted by Bogie Shooter

Gov Scott will take money from anybody for anything....just happens this is for a nursing home. Last year he was against having volunteers visiting nursing homes looking for poor conditions. Go figure. All political.

And in the grand scheme of things, $150,000 is small potatoes. How much is this high paid lobbyist in Tallahassee costing we the people, to say nothing of the high paid lobbyist we are paying in Washington. Hopefully, we will get our money's worth.

[djl8412]

Talk about being in denial!? Yes, the lifestyle is what we moved here for but we still need to be part of an entire population and should assume a sense of special entitlements. Some of the comments supporting special treatment of The Villages may very well be the fuel for outside residents sterotyping Villages residents and it's becoming easier to understand why.

[djl8412]

Originally Posted by djl8412

Talk about being in denial!? Yes, the lifestyle is what we moved here for but we still need to be part of an entire population and should assume a sense of special entitlements. Some of the comments supporting special treatment of The Villages may very well be the fuel for outside residents sterotyping Villages residents and it's becoming easier to understand why.

OOPS! My second sentence in the quote should have read "we still need to be part of an entire population and should NOT assume a sense of special entitlements."

[blueash]

Originally Posted by NJblue

The hotel analogy is precisely my point. Why does the government need to get involved with restricting beds when the laws of supply and demand already would do that? Just as a potential hotel owner may think twice about opening a new hotel if the occupancy rate in existing hotels is low, a potential nursing home owner would look at local occupancy rates before deciding to build.

The jail analogy is apples and oranges since jails do not operate under laws of supply and demand since they are government run and hence are a monopoly. However, in some areas there are privately run jails and I'm sure that these private operators do look at occupancy rates before deciding to build.

Now we are getting to the heart of the financial interest of the state. The hotel owner is now going to build a new hotel with beds that are not needed. Of course some consumers will use his hotel, which then lowers the occupancy of the nearby hotels. The total number of vacationers is not changed they just are more spread out. Here's where it gets interesting. The hotel owners all need to up their room rates to cover their costs or go out of business. However, they figure out that the government is having their officials occupy 80% of the beds and the government will pay more if that is what the local costs require. The very creation of more beds made the costs per bed go up, and payment of those increased costs is guaranteed by the state. (Medicaid and Medicare payments are determined by cost of provision of that service in that locality). Keep in mind that in Florida 80% of the cost of nursing home care is paid by the government which does not have the option of not providing that service. Supply and demand is not applicable to nursing home beds.

As to jails, if the government said to all private jails, We will pay you whatever it costs plus a profit even if your cells are empty you know there would be endless private jails. The limitation is that the government competes with its own jails which it will utilize if the costs are lower. The government does not have its own nursing homes, so there is not even that cost control for nursing homes. If a corporation is guaranteed to make money, why wouldn't they produce more of a product regardless of the demand because with nursing home beds, the more beds that are empty the more they cost, not the opposite.