Home Nursing Patients Caught in ‘Rules Trap’

Thank you for your outstanding article “Advocates of Patients Say Many Caught in Rules Trap” (Aug. 20). As a hospital employee who deals with these problems daily, I can verify that those who need home nursing are caught in a Catch-22 that prolongs their hospitalization for months.

Federal law requires that the only patients who are eligible for the home nursing program are those who are in an acute-care hospital while their application for the program is being considered by Medi-Cal. Thus, even if the family were willing and able to assume the tremendous burden of caring for the patient for a few months while the application is being processed, the rules of the game are such that this would disqualify them from the program.

Meanwhile, because Medi-Cal rates are about half that paid by private insurance, very few nursing agencies are willing to accept Medi-Cal patients, and they sit in the hospital for months on waiting lists. The truth is that not only are discharges being delayed for months but also that patients are being rehospitalized because nursing agencies are dropping them because of rates.

Although Medi-Cal has granted a few small increases in recent years, these are totally inadequate to resolve the problem. It is a penny-wise, pound-foolish approach that costs the taxpayers millions of dollars and results in unnecessary suffering for the patient and his family. Until the Medi-Cal rates are linked to a reasonable percentage of the usual and customary rates paid by insurance, this tragic situation will continue.

B.J. SOBIN

Fullerton