Nursing Homes Notes

I'm saving this comment which I left at a Facebook post.

I don't know how much good reporting it will take but sooner or later the country will be forced to come to terms with the yawning deficiencies of the for-profit medical-industrial enterprise passing for healthcare in America.

I only scanned this link because this has been one of my main hobby horses ever since both of my parents became Medicaid beneficiaries in their final years, despite a lifetime of basically good health, hard work and responsible living.

This line that jumped off the screen at me:

Many nursing homes are struggling in part because one of their most profitable businesses — post-surgery rehab — has withered as states restricted hospitals from performing nonessential services.

The protocol is widely understood. After three days as an inpatient, if someone is discharged directly to "rehab" by a doctor, Medicaid will pick up the bill for 99 days. Rehabilitation, of course, involves all kinds of assistance learning self-care returning to ADL (activities of daily living), presumably before those 99 days have passed.

So far, so good. There they receive physical therapy, occupational therapy, speech therapy, physical and mental exercises and counseling of all types. But the sad fact is that following a debilitating stroke or other reasons for which that first three days in the hospital was necessary, many of them will never leave skilled nursing care. After 99 days they are termed "custodial" and Medicare no longer covers "room and board". Those costs then become the responsibility of the individual or their family, and nursing home annual costs run up to and beyond six figures, well beyond what most residents are able to pay.

That is when they become Medicaid dependents.

I don't know how much Medicaid awards nursing homes for residents, but my guess is that it really is just enough to feed and house them and not much more. Since states control Medicaid disbursements, not Medicare/CMS, my guess is that those amounts vary widely across the country. In any case, about 65% of nursing home residents are Medicaid beneficiaries.

I had one Home Instead assignment watching out for the wife of an old man in charge of his bedridden wife while he went shopping and got a haircut. She had been a stroke victim several years before and he was her sole caretaker with occasional help from their daughter.

I was only there about eight hours and had time to chat with him to learn their backstory. I don't recall how old they were but both were probably in their late seventies or early eighties. She was incontinent, unable to walk or feed herself and spent most of her days in bed. He used a wheelchair to transport her to a lift chair in the living room of their small apartment, or the table where she had to be spoon-fed. He also did the cooking, washing of bed sheets, etc.

Knowing she was a prime candidate for a nursing home, I mentioned about that option and he told me they knew about that and she had already been to a nursing home on three previous occasions -- but only for 99 days, after which he brought her home. He already knew the drill.

I don't know their financial situation but they were not rich people. The apartment was well-furnished. I saw nice decorations and a lifetime of modest keepsakes, but I knew all that would vanish, along with whatever combined incomes they had from their working lives should they be forced to "spend down" to become Medicaid eligible. It was an unforgettable, sad situation which reminded me or my own parents whose only legacy was a few keepsakes, books and memories of a lifetime of hard work and responsible living.

Needless to say, this link touched a nerve.