Here's a letter I wrote to the San Diego Union Tribune, regarding the "death spiral" of Medi-Cal.

I read with interest your article in today's Union Tribune: "Nursing homes may have to cut corners or close". Did you know that there is a parallel crisis in the home-care nursing industry? I have first-hand experience with this, and am happy to share a bit of my story with you (perhaps it will lead to another article).

I'm a 47-year-old man with Muscular Dystrophy, and I use a ventilator (breathing apparatus) and power wheelchair. I'm also one of many patients in San Diego and throughout the state who receive nursing care in my home, under the NF (Nursing Facility) Waiver Program. This program, funded through Medi-Cal, allows patients to remain in their homes instead of being placed in nursing homes, as long as the nursing care they receive in-home is "cost-neutral" with nursing home care.

Unfortunately, the ongoing inadequacy of Medi-Cal reimbursement rates, combined with an overwhelming amount of Federal and State bureaucratic paperwork and the threat of further reductions in reimbursement rates, has led to an acute nursing shortage and the threat that people such as I will be left without care, made sicker and perhaps even die of officially sanctioned neglect. As an example, my current nursing provider, Sun Plus Home Care (on Chesapeake Avenue in San Diego) is unable to provide me with the 16 hours a day nursing care mandated by my plan of treatment. One of my nurses recently quit on short notice, and the agency is unable to replace him. This leaves me looking at 5 or more days a week with only 8 of the 16 hours per day of care I should be receiving.

The nursing agency's response to my plight is to tell me they are "trying" to fill the vacancy, while expecting me to rely on "backup" care. Backup care is required for home nursing patients in case of an emergency, but as an educated professional doing the best I can to live "the American Dream" independently, I cannot rely on my aging parents or friends to provide 5-day-a-week care.

My back is against the wall now, and there are many other home-care patients facing the same dilemma. Further cuts in the state's dismal Medi-Cal reimbursement rates will endanger the lives of me and thousands of others like me, as home-care nursing agencies are forced to stop accepting Medi-Cal patients and even close their doors, due to the unprofitability of running such an agency.

In my opinion, the state needs to quit obsessing over minor issues such as vehicle licensing fees (I too own a car, as do the nurses who will lose their jobs over these cuts) and find new solutions to the crumbling Medi-Cal system and the ever-increasing nursing shortage that Medi-Cal, Medicare, and HMOs have helped instigate. If nothing is done, we will soon be treated to the spectacle of more people dying on the streets of San Diego than the streets of Baghdad.