‘Powerful’ nursing home lobby helped craft advantageous system, officials say

The “very powerful” nursing home industry in Tennessee — with its campaign donations and lobbyists — has significantly contributed to the state sending 98 percent of its long-term care dollars toward the facilities, state officials and home care advocates said.

When it comes to long-term care, Tennessee has largely been a state reliant upon nursing homes. Of the state’s $1.2 billion long-term care program in TennCare, 98 percent goes toward the homes.

That ranks Tennessee last nationally in its funding mix of nursing homes versus home and community-based care, according to the TennCare Bureau.

As Gov. Phil Bredesen and state lawmakers look at reforming the state’s long-term care system this year, they will be hoping to allow the elderly and disabled on TennCare to be able to stay in their homes longer and drive down that 98 percent figure.

But how did Tennessee get on the “trailing edge” of long term care, 10 to 20 years behind the rest of the country, as Bredesen said last week, and send so many of its tax dollars toward nursing homes?

Bredesen, leading lawmakers and home-care advocates pointed to the powerful nursing home industry in Tennessee when asked how the state itself shifted to spending 98 percent of its long-term care dollars on nursing homes.

“I think, obviously, the nursing home industry is a very powerful industry in the state and has done a good job of keeping people focused on that piece of the industry,” Bredesen said.

Lt. Gov. Ron Ramsey (R-Blountville) said nursing home strength in Tennessee has “just been tradition.”

“We’ve just never tried to break that cycle and go with something new,” Ramsey said.

Government Dollars

Tennessee’s nursing home industry contributed $376,800 to the campaigns of current members of the General Assembly from 2004-2008, according to the combined political action committee disclosures of the two leading nursing home interests — the Murfreesboro-based National Health Care Corp. and the industry’s lobbying organization, the Tennessee Health Care Association.

Besides campaign contributions, NHC and the Tennessee Health Care Association spends hundreds of thousands of dollars on lobbying-related expenditures.

From Oct. 1, 2006 to Sept. 30, 2007, the Tennessee Health Care Association spent between $400,000 and $500,000 on employing its 13 lobbyists, according to state records.

Meanwhile, NHC spent between $75,000 and $150,000 for its six lobbyists during the same time period.

Gerald Coggin, NHC’s senior vice president, said the nursing home industry is well aware that it relies on government dollars to conduct the vast majority of its business.

“We realize that if you’ve got a business that … 80 percent of its dollars are controlled by government dollars, you either take part in that or you get taken apart by it,” Coggin said. “So we appreciate the opportunity to be able to sit down with administrations and legislators and explain what we’re doing on behalf of the citizens.”

While the nursing home industry has been organized and well funded, those lobbying for seniors to have more choices and to have the ability to stay at home longer have not been, said Dinah Bailes, a chapter coordinator for the Tennessee Assisted-Living Federation.

Bailes said her organization was only formed in the past 18 months.

“The lobbying for the nursing home association has done a terrific job,” Bailes said. “They just have been there at the table whenever those issues were brought up. So everything went their way.”

Expanding Services

Another reason for the nursing home industry’s strength in Tennessee is that Tennesseans simply need nursing services, said Rep. Dennis Ferguson (D-Harriman).

Ferguson, a legislative leader on the long-term care issue, said nursing homes offer around the clock care year-round to needy patients.

“We’ve had a lot of people that needed that nursing home service,” Ferguson said.

In addition, the state’s “fragmented” and confusing long-term care system, which the Bredesen administration is trying to simplify, has contributed toward pushing people into nursing homes, said state Finance Commissioner Dave Goetz.

While Bredesen is focusing on allowing more seniors to stay at home as opposed to nursing homes, NHC’s Coggin said his company, which operates 32 nursing homes in Tennessee, is supportive of the governor’s efforts.

That’s partly because NHC also offers home care, assisted living and hospice services, Coggin said.

“We look forward to the opportunity for expanding the services,” Coggin said.

Coggin argues that saying 98 percent of TennCare’s long-term care budget is spent on nursing homes is “incorrect” because the state spends a different pot of TennCare dollars on home-based care.

That separate pot of money, about $243 million in fiscal year 2007, goes toward home health and private duty nursing, said TennCare spokeswoman Marilyn Wilson.