NEWS STORY: Bill Would Allow Elderly HMO Patients to Choose Religious Facilities

c. 2000 Religion News Service WASHINGTON _ A bill that would require health maintenance organizations (HMOs) to allow older Americans to stay in religious care facilities is unlikely to pass Congress this year despite a strong push by Jewish organizations and broad support by religious groups. The “Return to Home” legislation would allow Medicare patients […]

c. 2000 Religion News Service

WASHINGTON _ A bill that would require health maintenance organizations (HMOs) to allow older Americans to stay in religious care facilities is unlikely to pass Congress this year despite a strong push by Jewish organizations and broad support by religious groups.

The “Return to Home” legislation would allow Medicare patients in religious facilities to return there for rehabilitative care, even if the facility is outside their HMO network. Supporters say it would increase the quality of care, while the insurance industry says it will raise costs.


The bill, which has been introduced each year since 1998, is currently in committee in both chambers. A small, bipartisan list of sponsors _ 50 in the House and 22 in the Senate _ is growing, but a shortened election year means Congress has fewer than 50 working days until the end of the legislative year.

Several Jewish groups have made the bill a top priority, saying a religious environment is important to many elderly Jews, and Jewish senior citizens want to live in community facilities they helped build.

The bill is also supported by an array of Protestant and Roman Catholic groups, from the Catholic Health Association of the U.S. to the Evangelical Lutheran Church in America to Baptist Senior Adult Ministries.

Here is how the bill would work:

If a Medicare patient living in a religious facility has an acute illness, such as a stroke or broken hip, and needs rehabilitative care, the bill would force HMOs to allow the patient to return to that facility regardless of whether it is in the HMO network.

Under the current system, a patient could be forced to go to a different HMO-sponsored facility far away from friends, family and doctors. Supporters of the bill say sending patients to unfamiliar facilities harms the quality of care. The bill would require HMOs to reimburse the religious facility _ or any facility of the patient’s choosing _ the same rate reimbursed to network facilities.

“We want people at the end of their lives to live in a place that culturally and religiously fits their needs,” said Reva Price, a Washington representative of the Jewish Council for Public Affairs. “To send them somewhere else just because that facility doesn’t have an HMO contract just doesn’t make sense. Send them back to their home.”

But there is also something larger at work. Judaism, which has fueled and fostered a sense of community as essential for survival, has long financed and built care facilities for Jewish senior citizens. It is unfair, supporters say, for Jews to pay for these facilities and not be able to use them.


“We think the very least that should happen is that the people for whom these institutions were built should have the opportunity to use them,” said Diana Aviv, the executive vice president for United Jewish Communities, an umbrella group for 189 Jewish federations across the United States.

Supporters of the bill say there are strong arguments for keeping elderly patients in a familiar, comfortable environment. They could be surrounded by friends and family, and doctors who know their medical history would be able to care for them.

Julie Trocchio, director of long-term care for the Catholic Health Association of the U.S., said the numbers of people affected would be relatively small. What’s more, familiar environments would help patients get better more quickly, ultimately reducing costs.

“The ability to have visitors just can’t be understated,” Trocchio said. “It’s just so important for someone getting better not to be in strange surroundings but to be back where they belong.”

There are also religious requirements that older Americans _ particularly Jews _ have, such as kosher diets. Often, they say, the religious community in a nursing home may be the only one they know.

United Jewish Communities has compiled testimonies from elderly Jewish patients whose conditions declined once they were sent to HMO-sponsored facilities. One such couple, Jonathan and Sara, lived in a Florida Jewish retirement facility. When Sara was hospitalized with kidney problems, she was released to an HMO-sponsored facility and not allowed to return to the Jewish community.


Once there, the UJC said, her care and condition worsened, and her husband could not drive the 20 miles to see her. Within months, she was dead and was never able to return to the Jewish facility.

“This is a home away from home,” Aviv said. “There is little difference about being (in a Jewish community setting) than being in their own homes.”

The insurance industry, meanwhile, supports the intentions of the bill but says it would drive costs up by forcing HMOs to deal with institutions that are not members of their networks. Richard Coorsh, a spokesman for the Health Insurance Association of America, said the purpose of an HMO is to control costs, not expand them by dealing with additional facilities.

The way to allow elderly patients to stay in their own facilities is for families to chose an HMO that does exactly that, he said.

“We take no issue with the merit or intent behind (the bill), but nevertheless we have to be mindful that ultimately the additional costs get passed on and the consumers are the ones who will end up paying for them,” Coorsh said.

DEA END ECKSTROM

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