Medi-Cal Cutoff Could Close O.C. Care Homes : Health: Many skilled nursing facilities cannot survive without payments. Residents would have nowhere to go.

Nursing homes throughout Orange County and statewide girded Friday for a battle for survival after learning that the state cut off all funding for medical services for the poor until a new state budget is signed.

“No nursing home administrator of a facility that takes patients on Medi-Cal (the state insurance program for the poor) can hold out forever,” said Roy Behnke, administrator at Harbor Health Care, a privately owned, 300-bed nursing home in Fullerton.

“It is causing psychological stress for patients and staff not only in our facility but every facility in the state,” he said.

While the cash flow of most hospitals will be interrupted by the cutoff of Medi-Cal payments, skilled nursing homes will be hurt even more profoundly. More of their patients are forced to rely on Medi-Cal because lingering illnesses and incapacities have soaked up their financial resources.

Many nursing home residents would have nowhere to go if the homes closed. The most elderly of them have outlived most of their family, and others have been abandoned. They also need specialized nursing. Some breathe with the aid of ventilators and are fed through tubes.

Kitty Creeth, president of the Orange County chapter of the California Assn. of Health Facilities, said the situation for nursing homes “is very, very serious. . . . It is critical and very scary because the people we take care of can’t take care of themselves.”

Roy Radley, 53, a victim of multiple sclerosis who can no longer walk, said he fears having nowhere to go.

“It scares me a little bit,” said Radley, a resident at Bartlett Medical Center in Santa Ana. “I have family, but I wouldn’t expect them to take care of me. It would be too difficult. My father is in his late 70s, and my mother is in her middle 70s. It wouldn’t be fair to them.”

Kathy Byrne, spokeswoman for the California Assn. of Health Facilities in Sacramento, said two-thirds of the elderly and disabled in the nursing homes rely on Medi-Cal. She said most of the 1,000 association members say that they couldn’t meet their payroll after more than two weeks without state money.

“And if that happened I don’t see how they could keep their doors open,” she added.

Byrne noted that largely because of the low reimbursement rate paid by Medi-Cal, an average of $72 a day, most nursing homes have been operating in the red for the last three years and thus would have great difficulty borrowing money from banks to tide them over.

Like administrators of many other nursing homes that care for the elderly and disabled, Behnke of Harbor Health Care has made contingency plans. He expects to survive in part by postponing payment of utility bills. The large size of his facility, he said, also gives him some bargaining clout with unpaid vendors.

Nonetheless, Behnke said he can’t really guarantee anything when his patients come to him asking for assurance that they won’t be left homeless.

“I’m not at all sure that someone should not file elder-abuse charges against the Legislature,” he said.

Orange County has 69 nursing homes, of which about 40 are state certified to accept patients on Medi-Cal. Industry observers say the homes in most dire circumstances are those that already are in financial trouble, have a large percentage of Medi-Cal patients and are run as independent, stand-alone businesses unaffiliated with a national chain.

“Half of the facilities in the state are independent, and I think those are the ones that will feel the biggest pinch,” said Rick Matros, president and chief operating officer of Tustin-based Care Enterprises Inc., an operator of 52 nursing and rehabilitation centers, including two in Huntington Beach.

Matros said Care, which has become financially stronger since emerging from a Chapter 11 bankruptcy in 1990, “will be OK for a while. But after a while, if it is not resolved, we will have to be cutting back on checks to our trade vendors.”

Vince Hambright, Orange County manager for Arkansas-based Beverly Enterprises, operator of five skilled nursing facilities in Orange County, said the blow of a Medi-Cal loss can be buffered by income from the company’s nursing homes in other states. “At this point in time there is no concern that resident care will be interrupted,” he stressed.

But Anita Tezano, director of staff development at Anaheim Convalescent Center, an 83-bed skilled nursing facility that is privately owned, said that home will be in trouble in another week if the state continues to withhold funds.

“We have all Medi-Cal patients, and if they don’t pay, we are out of business,” she said. “We can’t keep going like we are going. No facility can unless they own the United States Mint.”

When the state doesn’t pay the nursing homes, administrators say, it sets off a chain reaction as providers of nursing home supplies also aren’t paid.

Nor does it end there, noted Edwin Bernstein, a partner in Convacare Services Inc. of Van Nuys, which specializes in supplying nursing homes. “If the budget is not settled in the next few days, we won’t be able to pay our bills (from drug and other product wholesalers). Our biggest concern is that the wholesalers could cut us off.”

In several nursing homes throughout the county patients and staff members have joined in writing letters of protest to elected state representatives.

Art Bates, a 41-year-old quadriplegic at Orange West Care Center, a 99-bed skilled nursing home in Buena Park, said he has been “peeved with Medi-Cal for a long time. It is hard to get the services and medicines you need, and an awful lot of doctors will not see you.”

Bates, a graduate of Cal State Fullerton, is enraged by the even worse predicament that state legislators now are creating for the elderly and handicapped and the nursing homes that struggle to serve them.

Annette Brown, administrator at Orange West Care Center, says she is determined to keep it open. “I have patients to feed and take care of and we will do it in spite of the state,” she contends.

But Bates, who has been wheelchair-bound since he was 15, said he isn’t taking anything for granted. So this week he wedged a pencil between his paralyzed fingers and used “a hunt and peck system” to punch out on a computer a stinging letter to the governor, president pro tem of the Senate and speaker of the Assembly. Then he wheeled around the nursing home getting patients, staff and visiting relatives to sign it. As of Friday he had more than 60 signatures.

“The fact that it is taking you so long to pass and sign a budget is causing undue stress and pain to the citizens who elected you to office. We who work and reside in a long-term health care facility and the elderly and handicapped outside these facilities are especially susceptible to the problems caused by your inability to do your job,” the letter says in part.

Bates said that at each election he and other nursing home residents who are mentally alert enough cast their votes by absentee ballot. Bates, who is president of the residents council at the nursing home, said he is trying to speak and vote for the many who are more fragile than himself, such as those with Alzheimer’s disease.

“The handicapped never have had an equal voice in government,” he said. “But nobody is more dependent on government than we are.”