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Someone has to pay

7 Aug

As states begin to provide more home and assisted living services to seniors the number of nursing home beds begins to decline. A study done by Harvard Medical School found that a 10% increase in assisted living capacity led to a 1.4% decline in private pay nursing home occupancy. Most nursing home residents pay privately for nursing home care thus don’t affect the occupancy in Medicaid beds. In order to decrease the number of nursing home Medicaid beds, states must make an effort to increase funding for Medicaid clients living in nursing homes that want to receive services at home or in a Medicaid funded community care (assisted living) facility. To this day, the private assisted living industry takes Medicaid eligible residents only if they have an occupancy problem. They prefer not to deal with the complexities of billing the government and the excess of monitoring and reporting that goes with having a Medicaid resident. However, state Medicaid agencies are hard pressed to reduce the number of individuals in nursing homes paid by Medicaid if they are going to see reductions in their Medicaid long-term care budgets.

Although this move benefits clients who wish to remain at home, it drastically impacts the financial viability of nursing homes across the U.S. With less private paying clients nursing homes will start cutting back essential services to an ever growing number of very frail clients. What is more, some states like Pennsylvania are billing family members for the cost of nursing homes. The Pennsylvania law stipulates that family members of nursing home clients are ultimately responsible for the cost. Some families have been billed some $96,000 for the care provided to a family member residing in a nursing home.

At the end someone has to pay, either a family member or us, the taxpayers. What the story tells us is that long-term care in the U.S. is broken and needs to be reformed soon. One answer will be for states to continue to rebalance their long-term care program, provide more community care and make it easier for providers to want to work with the government.

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Impact of Supreme Court Decision on seniors

30 Mar

In June the U.S. Supreme Court will determine the fate of the healthcare reform and with it, the fate of many seniors in this country.  There is consensus that healthcare reform cannot be viable if the public option is deemed unconstitutional.  This comes at a time when the economic and health security of seniors is at its worst.  Healthcare reform,although aimed at the 40 million uninsured individuals, provided great benefits to seniors who cannot afford long term care.  Included in the healthcare reform were incentives to state to provide affordable long term care to seniors who want to remain in their communities and avoid costly nursing home care.

Lets take a look at what is at stake.  Debt and deficit reduction proposals by policymakers include major changes to thre three major entitlement programs, Medicare, Medicaid and Social Security.  Some proposals include raising the age of retirement to 67 years, asking higher income Medicare beneficiaries to contribute more to the cost of Medicare and federal block grants to states so they can pay the federal share of their Medicaid program expenses.  One mistake made by policymakers is to look at each of these programs separately and failure to recognize how interrelated they are in their effect on the economic security and well being of seniors.  For example, stopping annual increases in social security payments will result in less funds available to seniors to pay for healthcare.

Most seniors live on low or modest incomes, 1 in 10 have income below the poverty level ($10,458) and the number of seniors living in poverty increased when you take into account out-of-pocket expenses from 9 to 15%.  Many seniors today do not have long term care insurance coverage which means that assisted living and community care services are unaffordable or that paying for them will require a larger outlay.  It is predicted that low incme seniors will exhaust all their assets by the time they reach older age.  It is estimated that 2/3 of those 65 years and older will need long term care services.  Meaning that they will be solely reliant on Medicare and Medicaid to survive.  And yet most states restrict long term care funding in community settings forcing these seniors to enter nursing home care prematurely at four times the cost.  Dont they see the writing on the wall, or is it that they constantly engage in wishful thinking?  Those who will fare the worst are minority groups.  Poverty rates among black and hispanic seniors are more than twice as high as those among their white counterparts.  To compound the problem they suffer from a multitude of healthcare problems, again higher than the white seniors.  One wonders what information our policymakers rely on to make untimely and disastrous cut cutting decisions.  Not our seniors.