Wednesday, February 6, 2013

Quality first, cost second

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Next week is the deadline set by the Blaine County commissioners to decide how skilled nursing care will be provided for the disabled and elderly in the greater Wood River Valley. It’s not an enviable job.
    It would be an easy decision if it were only a matter of money—but it’s not. The quality of care to be provided through various options absolutely must be a major part of the commissioners’ decision.
    Medicare, the government health care program for older people, rates public and private nursing homes. Medicare.gov rates Blaine Manor, the existing public nursing home in Hailey, as a four- of five- star facility overall—above average.
    While cost is important—the county is currently subsidizing Blaine Manor with a voter-approved tax levy—the commissioners must ensure that any future option for nursing care be of the same high quality. They must also ensure that care is available to people of all income levels.
    Just because Blaine County has a relatively small population doesn’t mean it must settle for below-average care for its most vulnerable residents.
    What the commissioners’ choice should be is far from clear to a public that has watched while options evolved from meeting to meeting. The reason the best option is not crystal clear is likely because providing skilled nursing care over the long term is fraught with difficulty.
    Also, aging and disability are not popular subjects in our recreation- and fitness-centered county. That’s no surprise given that the local recreation-based economy depends on a reasonable level of fitness among residents and visitors.
    Contemplating that accident or illness can reduce robust human beings to a fragile, dependent state that requires others to care for them is not a happy exercise. But the alternative is magical thinking.
    The fervent hope often expressed by healthy people is that they want to die before having to enter a nursing home. Some joke that they hope the cause of death listed in their future obituaries will include the words “sudden and massive.”
    But talk is cheap; reality is not. The U.S. Department of Health and Human Services says that more than 40 percent of people age 65 and over will need nursing-home care sometime during their lifetime and that about 10 percent will stay there five years or longer.
    The commissioners should not choose an alternative solely because it’s cheap for taxpayers or will easily get the tough issue off their plates. They need to find a solid alternative that combines quality care with affordability.

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