The following is an excerpt from The Buck Still Stops Nowhere:
Long Term Care and Nursing Homes
The stealth danger in the health care system is assisted living and long-term nursing home care. Assisted living, home health and nursing home costs and staffing are grenades waiting to explode. Salaries for nursing home workers are not on par with workers in other sectors of the economy. Indeed, workers in the pet care industry often receive more pay than personal care workers in senior care facilities or in home health care.
Work in assisted living, adult family homes and skilled nursing facilities is hard work, involving lifting, bathing, feeding and caring for fragile and vulnerable people. People in these settings not only need health care services, they also need extensive social support services such as transportation and social engagement services to keep them mentally and physically engaged rather than sitting and staring at TVs.
The burden on caregivers, both family and others, is significant to arrange services, to tend to the person’s needs, to provide transportation, pay bills, organize medications and to find respite for themselves. Such demanding care even for someone they love deeply often leaves caregivers at risk of personal and physical exhaustion. Respite is desperately needed, but not always available.
The elder care industry faces a cost and access crisis that pales in comparison to other health care sectors.
There are not enough nursing beds to meet the needs of the current senior population much less the boomers who are just turning 65—the age of Medicare eligibility. By age 75 most people have one or more chronic diseases and will face at least one to three years in some kind of assisted living or nursing care facility.
Over 70 percent of all Americans think Medicare pays for assisted living and long-term care. It does not.
Medicare only pays for limited skilled nursing facility stays—up to 100 days. It only covers this care if someone has been in a hospital first. This policy is based on the assumption the person will recover after a hospital stay and return home. Only Medicaid, private long-term care insurance or personal family funds pay for the kind of nursing care for people who have chronic diseases such as Alzheimer’s Disease. Such diseases require personal care including dressing, bathing and eating. Personal care is not medical care and therefore is not covered by medical insurance.
Long-term nursing home costs are paid for either by family funds, by private long-term care insurance or by Medicaid. For Medicaid to cover long-term care costs people must meet Medicaid’s asset test.
Monthly dementia care costs can easily be $5,000 or more depending on the state and the facility. At this price family assets can rapidly dissolve. To avoid these costs and quality for Medicaid families try to transfer assets within the family so their parent or relative will qualify for Medicaid.
Once people have exhausted their personal assets, Medicaid will cover long term care in a facility. Exactly how and what Medicaid covers is determined by each state. Not all facilities accept Medicaid-funded patients.
Reams of rules and regulations have been written governing “transfer of assets” to prevent people from giving their assets to other family members. Medicaid which covers long-term care has been the fastest growing sector of state budgets. Medicaid now accounts for nearly 20 percent of state budgets and is second only to costs for primary and secondary education.
In 2002 Mississippi considered eliminating 13,000 Medicaid nursing home beds to balance its state budget.
Everyone in the aging industry and elected officials know about this lurking crisis but nothing seems to change. Nursing homes, assisted living facilities and home health care agencies remain squeezed by rate cuts.
Even Continuing Care Retirement Communities that promised life-long care face financial problems because of longer life expectancy and increasing care costs. Assisted living costs in these homes are in addition to purchase of the unit and monthly maintenance fees.
Other companies that once offered life-time long term care insurance are either going out of business or increasing their annual premiums by 15 percent or more because of increasing health care costs coupled with increasing longevity. Some companies even charge higher rates for single women because they have a longer life expectancy than men.
Kathleen O’Connor (c) 2001 The Buck Still Stops Nowhere: Why America’s Health Care is All Dollars and No Sense. (c) All rights reserved. Permission to reproduce/ introduce into a retrieval system or transmitted in any form or by any means must have the written permission of the author/publisher: Kathleen O’Connor LLC
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