Wednesday, May 11, 2011

Nursing Homes: They Don't Have To Take You In

The Times this morning reviews that talk about cutting Medicaid will affect more people than those parasitic poor brown folk: many nursing home patients depend on it:

The House plan would turn Medicaid, which provides health coverage for the poor through a combination of federal and state money, into a block grant program for states. The federal government would give lump sums to states, which in turn would be given more flexibility and independence over use of the money, though the plan does not spell out what the federal requirements would be.

Beginning in 2013, these grants would increase annually at the rate of inflation, with adjustments for population growth, a rate far below that of inflation for health care costs. As a result, states, which have said that they cannot afford to keep up with the program’s costs, are likely to scale back coverage. Such a reduction, critics fear, could have a disproportionate effect on Medicaid spending for nursing home care for the elderly or disabled...

According to the Congressional Budget Office, in the 2010 fiscal year, 77 percent of people enrolled in Medicaid were children and families, while 23 percent were elderly or disabled. But 64 percent of Medicaid spending was for older Americans and people with disabilities, while 36 percent went to children and families.

According to the Kaiser Family Foundation, which analyzes health care issues, 7 of 10 nursing home residents are on Medicaid, in large part because even middle-class patients often run through their savings while in a nursing home and turn to the entitlement program.

This is a huge deal. Typically, a middle class aged person goes into a nursing home, where the meter runs quite quickly. They start on Medicare, and, after they spend down their assets and become poor, they go on Medicaid, which lets them stay in the nursing home, and lets the nursing home stay in business. You cut medicaid, not so much. You turn Medicaid into block grants to states hurting for money, and likely to use it elsewhere, worse yet.

Which means that a lot of old folk would be out of nursing homes. Their kids' houses, bank accounts and lives are poorly, if at all, equipped for it. Visiting nurse agencies, home physical therapy, home visits by doctors? You may say I'm a dreamer...

Currently the aging parent's finances are independent (mostly) of the adult child's. That'll change very, very quickly if the Medicaid cuts go through, unless they're content to leave Granny out on the street. What will also change very, very quickly is the sort of financial guarantees from patients and their families that nursing homes will demand before admitting a new resident.

These people vote. They won't like this at all.


Ruth said...

In states where many hospitals are depending on the Medicare/Medicaid funds to stay in business at all, the effects will be felt first. And as you point out, the states will have many more demands on their funds, which will be allocated to their buds in many. It's a total breakdown that will make responsible children of aging parents choose between their retirements and their parents' care. Assuming, of course, that the kids will be independent when the aging part of the family gets to any age of dependence, if at all.

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ProfWombat said...

thanks--the negotiations, or what passes for them, are oft so vague in terms of what cuts will actually mean that people's eyes glaze over. A feature, not a bug, that...

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