They are the forgotten. They are the indigent by virtue of having to qualify for a government program by spending down all their assets. They are the frail and sick, utterly dependent on the largesse of the government. They are the thousands of residents at skilled nursing facilities whose monthly board and care is paid for through Medicaid. They are now the victims of a relentless mantra to cut government spending from the likes of Paul Ryan and Grover Norquist.
Vulnerable as a Baby
Many states have to grapple cuts and changes to Medicaid appropriations passed by Congress in 2010. It is no exaggeration to compare those on Medicaid in skilled nursing facilities with the vulnerability of new born baby or toddler. In the best of situations, they have a trusted friend or family member visit them a couple times a month. The vast majority have no patient advocate to ask about care and medical questions on their behalf.
Many are Grateful
There are over 870,000 Medicaid residents in long term care in over 15,000 assisted and skilled nursing facilities across the U.S. For better or worse, their bodies have out lived their savings or chronic medical issues have robbed them of their ability to work and care for themselves. They resign themselves to the reality that they must live three to a room with people they have never met before. Some are grateful, others are bitter and then there are those who have lost the wonder of the day due to dementia or, Alzheimer’s.
Complicated Medicaid Formulas
Medicaid works under a formula where the federal government will pay a minimum of 50% of the states’ program costs for individuals receiving Medicaid benefits. There are numerous formulas, waivers, income levels, benefits and eligibility factors to consider for each state. Even with the best of juggling, states come up short. In California, their Medicaid program, MediCal, is looking at drastically reducing benefits retroactively back to 2011.
Rural Facilities Hit Hardest
Hit hardest will be rural skilled nursing facilities that rely heavily on Medicaid reimbursement to keep the doors open. Eastern Plumas Health Care, a rural healthcare provider, is estimating losing $2.4 million this year alone if the proposed cuts go through. Like many of rural facilities, they are not sure their skilled nursing facilities even have a future with the cuts to MediCal reimbursement rates.
Seniors are Not a Spending Problem
It is easy to sit in a chair on a Sunday morning news show and pound the table that the U.S. has a spending problem. I am not sure how many Medicaid patients sit in their nursing beds and feel they are a spending problem. How we treat our elderly is a vital measuring stick of how good we are as a nation.
They may be forgotten, tucked in little nursing homes throughout our communities, but the poorest and oldest of our citizens are not a spending problem.
About Kevin Knauss
Privately paid long term disability is terribly MISREPRESENTED to consumers and heartlessly “dumps” needy individuals, weak and w/o lawyers they must endure the STING with no chance of winning, SIMPLE: they just find the individual as CAPABLE OF (some type) of occupation and require that the individual WORK NO MATTER WHAT! Quadriplegic…..can still blow up balloons for children right? Take public transportation right? Pain……is not acknowledged, only bio-mechanics! All of America should prepare to go to court for being unlucky enough to have disabilities, and to be grilled, challenged, treated like THIEF FOR ASKING for help from any source. That’s just the WAY IT IS!
Yes, there does seem to be a sense that sweat shops among the disabled are better than the “scourge” and “shame” of being on government assistance for some conservatives in our society.
When you have a Congressman making 174,000 per year and spending between 3 million – 30 million to get elected for a 2 year term; don’t tell me that seniors on medicare are a spending problem. What is their frame of reference for any type of government spending? Who created the spending that has become a problem? They have not accomplished anything in the last thirteen years but a lot of debt. Just calculate the cost of getting elected, and the debt they have created while in office, and the salary of $174,000 they earn each year vs. what they have accomplished or contributed for the betterment of this nation. WHO IS SPENDING TOO MUCH MONEY?
I am right with you. The overwhelming hypocrisy and irony of telling America we have a spending problem when Congress and Presidential candidates are the worst addicts to spending, is truly incomprehensible.
Many regular folks save and scrimp all their lives because we’re all supposed to support ourselves in retirement, yeah? But when we get frail, all our hard earned savings gets sucked right back out of us to pay for our “care” in “assisted living” which are drastically underfunded, understaffed, and often underqualified to do anything but drug their patients into silence. That is not living – assisted or otherwise.
After all our savings is gone, Medicaid picks up the tab. But often, after you’re dead, Medicaid then sues your heirs for anything you have left; the government put a lien on my grandmother’s house to pay back Medicaid for the care they paid for. That may sound fair on the surface of it, but I doubt my grandmother and grandfather who paid off their house decades before would have seen it that way.
So let’s see, they paid taxes into the government to fund Medicaid (among other things), they paid off their house, when my granddad passed away before he was 60 he left stacks of CDs so my grandmother wouldn’t have to worry about money, and the end result was that she had to go through all her CDs before she could qualify for Medicaid – some of which paid her property taxes and upkeep on her house, some of which paid her Medicare premiums, and some of which paid other taxes – then when she had no other asset than her poor house (worth all of $22K in today’s market), they finally put her on the Medicaid she and her husband had paid taxes toward in part so it would be there if they ever needed it, then to add insult to injury she was posthumously sued for her house to pay back the same Medicaid their income had funded in the first place.
We’re all cogs in the wheel, we pay the government while we’re able to work, we pay them when we’re not able to work, and we pay them again after we die. What’s the point of scrimping and saving and paying off the mortgage early and funding your own retirement when the government is going to take every freaking dime anyway?
It’s certainly not so you can receive adequate care when you’re old and frail. Nursing homes are so understaffed and underfunded that the staff can only do the bare minimum and often cannot even do that. If a patient does not have an advocate their medication is screwed up, interactions are not only not caught but are treated with yet more drugs and the goal is for a patient to be quiet and not make a fuss – make a fuss and you are declared depressed and dosed or belligerent and dosed. Until you die. Period.
And if you don’t make a fuss and are quiet? No one checks on you for hours, you may or may not be fed, and the most you see staff is after shift change. Most staff do care, they are just overwhelmed with too much work and too many useless regulations and procedures that do not take care of the actual needs of the patients. The rest of staff have burned out to the point of being apathetic, just clock in, do as little as possible, and clock out, in an effort not to let their brain engage because it hurts to care when you can’t actually do what needs to be done to care for your patients!
It’s a horrible system. Horrid. And the only thing more horrid than the patients’ existence is the fact that more nursing homes are privately owned, which puts profits above patient care, while publicly putting helpless patients on trial for draining government money with their “entitlements.”
BTW, go ahead and collect your Social Security retirement at age 62. Simple math will tell you that you won’t lose overall money collected until you hit about 76, and within a couple of years (if you live that long) you’ll be in a nursing home anyway and won’t be collecting your SS check – the nursing home will. So why not use your money now rather than wait and let the nursing home owners enjoy the profits of your frugality? If we’re all headed there anyway, we might as well carpe diem. We paid for it, we ARE entitled to it.
I think you have covered the economic theory pretty well. My father was in a skilled nursing facility for 5 years. I was grateful. It was not the best place, but I was his advocate, visited 3 times a week, got to know the staff and they took care of him as best they could.
That’s the endless conundrum – that today we can’t take care of our elderly family ourselves because we’re working so hard and doing so much and healthcare costs have risen so high. We do have to get to know the staff – and staff are usually very glad that someone is advocating for their patients (advocating, not just screaming at them). They can’t possibly keep up with it all.
My mother-in-law was in a decent facility (she had nursing home insurance and that helped), but when you have 4 different doctors prescribing, something is going to get screwed up. When Mom started feeling bad we knew something was off and we got her chart and checked all of her meds ourselves. Sure enough, we found a dangerous interaction with a high potential for fatality because 2 different doctors were prescribing without consulting the main doctor.
I feel so sorry for those who don’t have someone to advocate for them, someone to oversee their care and keep up with “the big picture.” It’s hard enough when you’re younger and have to be in the hospital or need regular medical care for chronic conditions, but when you’re older and may not have understanding of what’s going on with your own body, it’s terrible.
A civilized society is judged by how it treats its helpless citizens, its children, its elderly, and its poverty stricken. With many of our political leaders pushing an “every man for himself” attitude, we seem to become more uncivilized every day.