There must be a huge lobby for nursing homes. Paid for mostly by Medicare. After qualifying you get six weeks I think in NYS then leave and wait to qualify again.
Unfortunately for family home care there is no reimbursement even though you are saving the government money. Should be a tax break if you are paying your mother's aides and food to keep her in her home. https://www.medicare.gov/coverage/skilled-nursing-facility-care.html
8
Having worked in a nursing home I can tell you there are many sides to every story:
- the elder who gifts all of their property/monies to their kids then 5 years later expects to live for free in a nursing home on Medicaid while the kids enjoy their new found wealth
- the families who place their parents in for-profit nursing homes that usually have no compulsion about putting the parents on the street when their monies run out
- the non-profits who often accept the parents who are thrown out of the for-profits but then suffer financially cause Medicaid payments do not cover costs
- the seriously destitute people whose kids struggle to keep them safe and cared for at home then finally need to concede to Medicaid nursing home care but then can't find a nursing home to accept the parents
Solutions? Extend the Medicaid financial look back period from 5 to 10 years. That will eliminate many of the system scammers and free up funds. Kids: face that fact that if you decide to place your parent in a facility that will not keep them when their money runs out, it is now YOUR responsibility to pay for your parent's care. Don't expect a non-profit facilty to now accept your parent on Medicaid after you've given your parent's money to another facility. Families with true need: don't give up hope. Apply for Medicaid and look for a highly rated facility (medicare.gov/nursinghomecompare) that has Medicaid openings and apply. I wish you good luck.
20
We shouldn't control guns, because the elderly will need them -- to shoot themselves in the head if they have medical needs. Beats reforming healthcare . . .
18
The good old American profit before people scheme. And we are supposed to appreciate the sanctity of life.
There are some things that the profit-based system just doesn't work; Healthcare and the postal system to name two.
14
I work as a nurse. I understand the sentiments here, especially regarding cost of care. The system is very broken, nursing homes and hospitals are overflowing, and use of these resources only is increasing. I have an unbelievable amount of empathy for these patients.
But for a moment please consider your own wages for 40 hours a week. Then consider the cost of care and facilities that you expect to pay for facility and staff 24/7. Then consider the expectations on 911 services and hospitals. There's unbelievable waste in this system, but also absurd expectations and gross abuse by our fellow countrymen in addition to poor staffing and practices by the facilities. We are not meant to live forever, and we should stop acting like there's an expectation of that until our loved ones are in the CCU on a ventilator with several pressors.
12
Is it financially possible for a nursing home to operate while being paid $200 a day per person? It may fuel our righteous indignation to attack the businesses for being heartless here but I wonder if the real problem is poor medicaid funding. If the nursing home goes bankrupt, they won't be able to care for anyone.
10
Just another example of fourth rate medical care in "the richest country in the world".
If these examples don't bring shame upon us, then nothing will.
22
How to make AmerIca great again? Single payer for us all. This “system” of tiered Medicare/Medicaid, throw’em out when reimbursements are reduced - a travesty.
My parents did all they could, saved all they could. Both had Alzheimer’s. Fortunately my mom died at 90 shortly before her money would have run out. The stress of managing it all was excruciating. And I lost considerable savings. I am grateful and honored to have cared for my parents. But I lost faith in the “American system” of healthcare for the elderly. It is a shameful, inadequate charade. One thing worked: Tricare, available because my dad served in the Naval Reserve over 20 years. Single payer already exists and it is called Tricare.
29
Obviously the GOP needs to get right on this problem. These old ill people are interfering with the rights of noble business owners to maximize profits.
12
Fund wars but not our own that need it the most. Saddest and scariest news of the week.
18
And when they kick out all the immigrants they can, who will fill all the low level positions in nursing homes and as home care workers? Even if hourly wages increase -substantially -who will take those jobs?And, of course, care of every type will only get more expensive.
Good job, GOP and Trump.
14
"He also said the home “unequivocally” denies that it wrongfully discharged the patient."
Walks like a duck, quacks like a duck, even looks like a duck...but is professed to be a chicken. Sure thing Sport.
9
It is a shame that the NYTimes didn't point out that this has been going on for 30 years or more. Nursing homes love Medicare, they over-charge and walk away with billions. Many nursing homes are a part of large investor groups that create companies within companies, making it hard to go after them due to existing investor laws. It goes much deeper than is presented here, and that is what needs to be fixed, not some clarification of the eviction laws.
22
What's new? If you can no longer work/produce revenue in and for America - you are considered a liability. We are a heartless country. America: "Big on promises, short on delivery."
14
Welcome welcome to,tea party America. Isn’t it nice what good Christians like trump do to their fellow citizens. Evangelicals should be so proud of this.
15
Just one more reason to take the profit motive out of health care.
21
NYT was wrong. The Nursing home did not say she has to go to a homeless shelter. The Nursing home had completed her care but was kind enough to keep her until her Medicare coverage expired. At that time, she has to be discharged. It is her and her family to find a place for her after discharge and they elected to go to a homeless shelter. It is the problem with this Country, the family shirk their responsibility to take care of their own and expects the government to pay for their care. The Nursing home cannot afford to keep people who cannot pay as it tis the quickest way to going into bankruptcy.
6
Here at home we made a pact to just die when the diagnosis comes . . . Can't quite stomach 1) impoverishing my spouse so I can die later surrounded by people who don't really care whether I live or die and 2) giving every cent we've managed to scrape together through Ronnie Ray-gun to the imbecile currently sitting in the oval. Just die.
9
And how do you manage that, exactly? "Just die" assumes that you are mentally aware enough at the time of your diagnosis to arrange your own death, that you have means to commit suicide easily available to you, and that you're physically able to carry out whatever method you choose. By the time you get "the diagnosis," you are most likely no longer able to carry out suicide. Many of us in our 60s and 70s are now seriously discussing suicide as a way to avoid the horrors that are obviously awaiting us when the Republicans slash Medicare, Soc. Sec., and Medicaid. But that would mean picking a time to die BEFORE true impairment sets in.
9
How many other elderly and sick folks must feel the same despair and hopelessness? Is this the future we are presenting to our parents and grandparents who have loved and nurtured us? Americans, we should be ashamed.
11
Seriously? What in the name of God is happening to your country?
17
Another disgrace in America. I hope you red state voters are happy with your loved ones out starving and dying on the street. But you get to keep your guns that's the real victory!
20
This article is very misleading. It mentions buried in the middle that Medicare pays for rehab, but the entire article suggests that people who need long-term or custodial care are being kicked out of nursing homes because Medicaid pays less than Medicare. As is clearly stated in "Medicare And You", the booklet every Medicare recipient receives annually, Medicare does not cover long-term or custodial care. It covers at 100% the first 20 days in a skilled nursing facility for rehab after a minimum 3-day hospitalization, 80%, requiring a co-pay for the remainder, for days 21-100, and pays nothing after 100 days. The purpose is for skilled care so that the patient can return home. If long-term care is needed, means other than Medicare will be necessary, as the status of the patient has changed from rehab.
This is nothing new. If the nursing home is primarily a rehab unit, and the patient needs long-term care, the patient would have to go elsewhere. If it provides both short- and long-term care, the patient may stay if the home has a long-term, but the status is changed.
By not clearly delineating the difference between skilled nursing short-term rehabilitation and long-term care, you are doing a disservice to both the patients and the nursing homes and adding more confusion to what is confusing enough already.
18
This is only the beginning. The real Reckoning will come when the middle age, middle class who are exhausting their resources to care for elderly parents and grandparents find themselves needing care in the future. At least their parents and grandparents for the most part had significant savings to exhaust before the nursing homes put them out on the streets. Many middle-class people have no such savings and certainly not lower-income people like the poor amputee living on $800 a month. Our society will have to decide if we are going to pay the cost to care for these people when the time comes or be comfortable with stepping over homeless elderly people on the streets.
I live in Queens. I now avoid going to Manhattan unless I absolutely have to. More homeless in the streets everyday, and too many of them are elderly people. Is this the kind of parasitic Society we live in, where it's okay to discard people like trash on the street when they are no longer useful. And why doesn't a lifetime of work and contribution to Society, however modest, guarantee an individual basic care and dignity at the end of their life?
33
As an elderly person, I see a clear difference between living and being kept alive. Our medical systems have successfully eliminated the negative impact of any number of elderly diseases that formally gave a desired exit from life to the deteriorating elderly. Most of the people of my age group, who I talk to, are not as worried about dying as they are about how they are going to die. Being warehoused in an uncaring, underfunded mass care system while our ability to pay our own way diminishes by the day is the nightmare that haunts our thoughts. Yes, we should have saved more, but how realistic is it that an average middle class individual can save the hundreds of thousands that many need for good care at the end of life.
34
Saying that "often" the reason for discharge is that Medicare coverage has stopped is inaccurate. "Nearly always" would be more accurate and honest, and this has been true for decades as anyone in the field knows.
28
Medicare does not and never has paid for long-term care in a nursing home. It only pays for rehabilitation for 100 days, as is clearly stated in the booklet every Medicare recipient receives. People who need long-term care in a nursing home have always had to have other means of paying for it. Usually, when their personal funds run out, they go on Medicaid. That may be the time when people are getting discharged because the reimbursement is lower than the regular nursing home charge, but it has nothing to do with Medicare. And this is why people are urged to have long-term care insurance.
3
From personal experience: When you have a family member in long-term nursing care, first you spend down all available retirement capital to meet the monthly cost of $11,000 and up. When that's exhausted, you apply for Medicaid. But note that it's not a free ride, because you're still paying all available income (Social Security plus any annuity plus any remaining savings) - just that the monthly cost can be reduced, for example to $8,500. per month. And the judgment of the Medicaid office is final.
23
The way the USA treats its citizens is unconscionable. No one should be left out on the streets to fend for themselves, especially not the elderly, the disabled, or kids.
Not all seniors or disabled people have a family that can take them in. In fact, for many, they no longer have any living relatives at all.
The sandwich generation is stuck between a rock and a hard place. They have both children and elderly parents to care for an often that means sacrificing their own retirement funds to care for those family members.
Too many seniors are on poverty wages and section 8 housing is hard to come by for them as that program also keeps getting cut.
Until politicians start caring about the humans in their districts and not just the corporations and the campaign cash they get, we are going to continue to see the deterioration of this society.
Instead of giving huge tax cuts to the wealthy, corporations and the middle-class Trump and his greedy minions should have INCREASED taxes on the wealthiest to pay for Medicare, Medicaid, Social Security, and infrastructure upgrades.
Instead of giving more money to the military, they should have closed more overseas and domestic armed services bases. We should not need over 800 of them. After all, there are only 195 countries in the entire world and most of them are not our enemies.
We need to take better care of our most vulnerable populations.
38
It is a complex issue. We will never be able to adequately care for people in their old age, care for them as a truly civilized society should, until we put more money into the system. Naturally patients and their families what great care, but even adequate care costs money. Nursing and rehab homes are notorious for their low pay and less then optimal working conditions, which are, in part, the result of the minimum both the government and private insurers are willing to pay for such care. Low pay means high turnover at least of the best aids and nurses.
I worked for a while as a PM nurse in a nursing home - a fairly upscale one part of a pricy retirement community. The pay was quite a bit lower than area hospitals. It was not uncommon to have the night nurse call in sick. In that case, I would have to stay not until 10PM, but until 6:30 AM - with no sleep, no food to sustain me through the extra 8 hours etc. There was always a second PM nurse, but most of those gals where Filipinos who worked a night shift at another facility so that they could send money home to family. I did not stay there long, though I liked working with the elderly patients.
There is no excuse for what happened to some of these patients. That said, many of these facilities struggle to keep decent staff and to cover costs. Adequate nursing home care is not cheap.
21
So it has begun... People seem to decouple their political action and societal changes.
9
Another thing to acknowledge is that skilled nursing homes often hire social workers that are Bachelor prepared with little to no experience to save costs. In my opinion they are ill prepared to address many of the issues or to educate families and clients on the system
10
Reimbursement for residence in a Skilled Nursing Facility varies by payment type. Private is highest, followed by Medicare and then Medicaid. (With various sub stratas). Most people who go to nursing homes for long term care end up using Medicaid to pay. Medicaid reimbursements to homes are not a flat rate. They are based on the level of acuity of the residents and the costs to run the specific home.
Many homes show little or no profit as their expenses are very close to their receipts. The For Profit sector of the industry makes its money by bumping up the underlying cost of the business: They pay high rents to "other" companies and contract services from "other" entities. Then Medicaid pays them more for their costs - all of which goes straight to the contracted services and property owners.
If I had to put my parents in to a long term care facility, it would be a non profit close to home, where the care providers seem happy, and there are enough of them around. Often you have a very short amount of time to make this decision. A crisis occurs, and you need to act fast. If you are close to this point in your life, you might want to understand your options prior to when the crisis occurs. (And hopefully it never will).
26
Well I suppose those who are mobile could rob a bank, then sit down on the curb and wait to be arrested. That way, the state will pay for room, board, and medical care. A prison hospital/long term care unit may not be ideal, but it's better than the streets.
35
Nursing homes and assisted living facilities are too expensive. The federal and state governments must address an emerging problem--the fact that our growing elderly population wont be able to afford long term health care in the future. We need to create affordable long term health care facilities for our frail elderly population. Currently, there are many facilities for those who can afford the prices but inadequate beds for those who cant. PAUL FEINER Greenburgh Town Supervisor
22
And you'd know Paul, since Greenburgh is in Westchester County NY, one of the most expensive places in America.
7
Worse yet, long-term care communities state that the reason for the high cost is increasing wages for their workers. Nothing could be further from the truth. Rarely does a front line staff member earn a living wage. This is the other tragedy unfolding.
16
And yet Paul continues to push for for-profit assisted living, given away huge variances.
1
Americans aren’t aware that Medicare will only house a patient in a nursing home for about 24 days. After that, the patient comes under Medicaid. In fact, the majority of nursing homes patients are covered by Medicaid. And if the patient has any savings or a house, Medicaid will not start paying until the patient has less then $2,000.00 left. Finally, if the conservatives in Congress cut back Medicaid by almost one trillion dollars, more elderly and chronically ill patients will wind up on the street.
42
I'm concerned about the plight of people discharged but I'm also thinking I'd never want to invest in or own a nursing home and I figure a lot of other people will conclude the same thing and there won't be enough nursing homes. We could have the federal government own and operate nursing homes but we're over $21 Trillion in debt now. Ah for the good old days of 2004 when it was only $7 Trillion.
10
It’s a matter of priorities. USA is the richest nation the world has ever known.
2
Nursing homes should have a banner outside of their facilities: "Profits not People". Oh how they love that money, government money, the more the better. A program that reduces their government take- no way! Throw them bums out on the street. They're sounding more and more like many hospitals. Patient dumping at it's finest. Gotta love America, Trump, the Republicans and of course good old fashioned American capitalism.
15
Still enjoying that tax cut?
4
Patient and granny dumping have been going on a lot longer than since Trump was elected. My wife was a geriatric Physical Therapist nearly 40 years ago and it was going on then.
5
When you report both that the problem is the loss of familiar surroundings and that these people are discharged after 20 days, you have succumbed to a superficial understanding of what happens in skilled nursing communities. Call me, NYT. I would love to illuminate.
1
Fairness, equity? My uncle saved money all his life on a small salary. When he went into a nursing home he had 400,000.00 in savings. we later learned that he was the only one paying. The others had spent their money, long ago but they got the same care as my uncle. Wanna game the system? Don't save a dime, take great vacations, eat out three times a week. When the time comes and you got nothing, you get the same treatment as my poor uncle.
42
Wait a minute. Where are they discharging these patients to, considering they may be a danger to themselves and others? Out on the street? To homeless shelters? That would seem to encourage a public health problem. Let's face it. The Republicans, starting at the top, couldn't care less that the elderly are not being properly looked after. If it were up to them, the sick, disabled, infirm and exceedingly elderly would be put on the mountainside to die quickly and invisibly. Problem solved.
26
Someone posted here and said they'd work themselves to death before putting their parent in a nursing home. Well, that is close to what I did. Several years of care, sudden loss, well over a year since that, and Im still a mess. PTS, depression, literally sickened by what our system is about and capable of and sickened by the weight of the responsibility that I took on, which I did gladly and without regrets. But it had its costs.
Now if I could do anything with my life, it would be to dedicate myself to help reform this mess. But as I struggle psychologically, I struggle financially and that dream is deferred. Oh for a guaranteed basic income.
Other than that, my only other dream is to die young.
32
Most unfortunately, I completely relate to all you said. In fact, I could have written your comment myself. There's something wrong with our country that offers no support for the caregivers who are saving the taxpayers billions of dollars.
23
God bless you - now it’s time to take care of you, caregiving is exhausting yet gratifying work. Thank you for being such a decent person and I wish you health, comfort, wealth, peace, and love. God bless you
17
Thank you so much for your kindness. At this point I wish I didnt believe in a Higher Power. It would be easier then the dilemma of feeling there is one and that my pleas for my dream, and yes, some simple comfort and security, are met with a shrug.
Maybe feeling that way is not right when they are so many in worse situations, but I want to be one of those who make those worse situations better. Makes me sound unworldly I suppose. Far from the case, Just trying to hold onto my decency in the face of so much inexplicable indecency in our country right now.
6
What should nursing homes do?
They have to pay staff, utilities, too. A single payer system may be the only alternative eventually, which would be wonderful.
You think think things are bad now? Wait til the billions of dollars of Trump’s budget cuts come to Medicare, Medicaid, and Social Security. We’ll all be thrown out into the snow piles.
41
I thought this article was very misleading. First of all, Medicare only pays for temporary stays in rehab, and rehab ends when the patient stops improving. Medicare doesn't pay for long term stays in nursing homes, although many people think it does. Long term stays in nursing homes are either paid for by private funds or Medicaid. And Medicaid only pays if the patient has liquidated most of their assets. Those are the rules, but, again, many people don't know this. These rules have been place long before Trump.
The rules could be changed to have Medicare pay for long term care, but this would increase the expenses of an already expensive program, and these expenses are paid by taxpayers.
Nursing homes are private businesses. You will probably get better care if you pay higher private rates as opposed to the lower medicaid rates, because the nursing home can afford better staff and facilities. But under no circumstances will Medicare being paying for long term nursing home care the way is does for short term rehab.
The article seems to totally equate rehabilitation care with nursing home care in a way that is misleading to a readership where most people are already under the false impression that Medicare pays for nursing home care.
51
Exactly right. In addition, in order to be admitted to a nursing home under Medicaid a resident must pass a Pre Admission Evaluation. If they are even minimally functional, mostly cognitively intact and can transfer themselves etc the PAE will be denied by Medicaid and the nursing home has no choice. A person can not live in a nursing home with Medicaid paying the bill just because they have no better place to go.
11
Thank you, DWS for stating exactly what I wanted to say.....this article contributes to the generally appalling misinformation so many Americans have about their own government programs. I am aghast the NYT editors allowed this to go to print in its present form. Thanks for detailing some of the information that should have been included in the article for the sake of clarification.
2
More money equals better care? Not in America. It might mean prettier surroundings but not better, more compassionate care.
3
This happened to my Grandmother. She spent her life savings (or we spent her life savings for her) on her place in a nursing home. Once all her money was gone, we sold her house. That all went to the nursing home. Then we paid. All in, we paid them $625,000 in the late eighties. They kicked her out when we could no longer pay the supplement, and her care was coming from medicaid alone. Care facilities that accept medicare should be required to maintain a place for residents who have run through all of those benefits.
28
Trump care: treat people like human garbage, even your grandmother. Especially your grandmother. This is the future of all of us unless we dump Republicans and their limitless greed.
45
Listen, I hate to defend Trump but this system was in place through eight years of Obama and all their predecessors.
4
Perhaps you missed the part where she said it was in the late '80s? That's long before Trump was elected. Is there nothing you people won't use even mistakenly to knock Trump?
Keep it up. You're making it easier for Trump to be reelected in 2020.l
4
Nursing homes are all about profits. One of my aunts and her daughters all became millionaires owning nursing homes. And now the daughters children are in the business.
15
You know what's pathetic? Many seniors voted for 45. Regrets, I bet they have a few now.
22
Be careful what you wish for, you just might get it.
4
This has been going on a lot longer than since "45" was elected. My wife did geriatric Physical Therapy in nursing homes decades ago and it was going on then.
3
This is what "Trump Care' will look like to all of us.
14
The ultimate result of private insurance, and tiered basic benefits. In Germany now there are two tiers, and the current controversy is that folks on the lower tier should get the better level as well.
4
...because you can't use "Trump" and "care" in the same sentence unless you also use the word "money".
1
Single payer, NOW! No more medicare, no more medicaid, no silly "medicare EXTRA"--the same for everybody. No more insurance companies, no more excuses for not taking care of patients.
39
My father ran into a similar situation. The only good news is that he had a family that could jump into the breach. As it was, we barely were able to find him a safe place to be before he was "kicked out" or we would need to start paying exorbitant daily fees personally. We had reserved an assisted living apartment for him in another facility. Those fine folks decided that he was too much of a risk for them. We had paid the monthly fees to reserve the room. They would not return those unused fees including the additional fees we paid for additional care that he never would use. When I asked the nursing home folks how we were expected to find him living accommodations in three days, they basically shrugged. Not their problem. Fortunately, by calling around I was able to find an amazing place for him that happened to have one opening. This is an inconceivable situation and my family and I lived through it. No notice. No room at the inn. He cannot move into the room we have been paying for because he was too fragile. No money to be returned. Furniture to be moved back out that had never been used. We will always be grateful to the amazing small, local, caring residence that was able to take him in and restore his health for the last four months of his life.
26
Their CEO and stock owners were very pleased though.
9
It is ludicrous to expect career bureaucrats at the state or federal level to protect nursing home residents who are among the most vulnerable in our society. These career - how many days to retirement? - mannekins do nothing except regurgitate form letters to those who protest inhumane conditions in long term care, New York State is one of the worst examples of career simpletons who sent form letters filled with gobbledygook. God help people whp need long term care in this country. It has become the coldest of robber baron industries.
17
But seniors voted for Trump so they get what they voted for. They just didn't expect they would be hurt.
1
It's only going to get worse! These are the most mean spirited times in American History!! There is no sense of community or concern for the other anymore!!!
44
And we are the best country that has, is or will every exist under some god or another? I ask what god? What country? Look, why doesn't our Republican controlled government just come out and tell the old, the poor, the school children riddled with bullets, "Hurry up and die, you're costing too much to keep alive!" Face it fellow citizens, we are a failing democracy of easily led sheep. Keep quiet and die. Change out the government and stand a small chance of living.
23
And why are we a failing democracy? Because of the insatiable greed of the rich and the powerful.
10
These Nursing homes sound like blood suckers, they suck the life blood out of you then dump you on the street.
Probably run by private equity, banks and heartless, clueless, pension funds.
They get the money and the (poor, average person) tax payer foots the bill in terms of social cost to society, and all the other costs that will be incurred like when the police and fire departments and ambulance services are called to pick someone off the street, or when a helpless senior winds up in a hospital emergency room, or when they have to go pick up a dead body.
We have a cruel and despicable system. Shameful!
9
One can be happy not to live in the states
16
The Trump administration’s assault on Medicaid — and after that, Medicare — will only further reduce options for the elderly and wreak havoc on the lives of their children or other caregiving relatives. When all is said and done, that puny middle-class tax cut will go directly to room and board for grandma.
But, hey, we live in the greatest country in the world, right? USA! USA! USA!
18
The recent tax cut will put billions over the next few years into the pockets of the richest one hundred families. Meanwhile our fellow citizens get dumped out of nursing homes for lack of money.
What kind of society have we become?
People have a right to buy a weapon of war but not a right to a health care and a nursing home when needed.
What insanity!
25
I am the psychiatrist in NYC, the Bronx in particular. NH are the worst places to be in for an older person. Almost all clients get a diagnosis of some kind of psychiatric illness. Based on nothing. But, many of those nice old people are only demented. So why they have a psychiatric diagnosis then. Because there is "black box" warning about increased stroke incidence for patients with dementia given antipsychotic. By giving them a false diagnosis of schizophrenia/ schizoaffective or bipolar disorders, one can avoid liability for using antipsychotics as a chemical restaraint...shamefull...in my view...
28
Thanks for this insight.
7
my pleasure...if it helps a little...
2
And you think it is better for people with assets? In FL there are predatory professional guardians who engage in racketeering with assisted living facilities, attorneys appointed by the court to "protect" the interest of the ward, doctors who will always diagnose a potential ward as incapacitated, and judges who oversee the proceedings with a blind eye in return for political contributions and support. Oh, and I almost forgot - the spotters, better known as social workers who are looking for elderly people with assets, no estate plan in place, no immediate or local family, but plenty of assets. Everybody gets their cut. Once the ward is confined they are sedated to the point of compliance and the pro's go to work converting their assets through various schemes, including filing numerous pointless motions in probate court with guardian and attorney deducting all fees from the estate.If you doubt this, google "guardianship abuse in FL" and think twice about retiring there to enjoy your golden years.
22
You couldn't pay me to retire to Florida, given the evil of its state laws. Stand Your Ground, no discussion of banning automatic weapons days after 17 Florida students were killed -- you can keep the whole state. I'll visit once in a while. Maybe.
2
This is truly awful. What a national disgrace. No compassion. Health care cannot be ruled by the bottom line .
7
Many people do not realize that Medicaid’s biggest expenditure is nursing home care. And most of those patients are from red states. People need to die sooner, it’s cheaper.
13
I used to take care of severe nursing home patients living in different facilities. I also conducted research on quality of medical care in nursing homes over a decade ago. Later I advocated for the care of my own parents and relatives. Everything this article is not surprising to me.
1) Ours and others' work basically show that given a choice, pick a home that is a non-profit, religiously-based, or run by a family (e.g. not a major national chain). Otherwise, profits will almost always be put ahead of care.
2) Pick a place near your home where family and friends can visit regularly. Often older folks are vulnerable and cannot advocate for themselves. Join the nursing home resident/family council at the home.
3) Don't let the fancy furnishings or food fool you. The most important part of a home is a caring staff. Talk especially to the lowest-level staff, the nursing assistants -- they're the ones who will actually give care.
"patients could not be discharged without a doctor’s order " -- pls. clarify this. Does this mean the patient's own doc or the nursing home director (also an MD) who is under the pay of the home and thus has a conflict of interest?
Medicare should punish homes which have discharged patients unfairly by not allow ANY Medicare patients in them. Cut them off at their knees.
24
This is before Trump’s cuts to Medicare and Medicaid.
11
So it is OK? Got it.
1
I don't think that's what Christopher means at all, Jeff.
2
So where is the concept of family in all of this? How is it that we've evolved to the point where taking care of our family is someone else's problem? People have lost control of their life's priorities, chasing after things they think will make them happy and ignoring their blood. Then it becomes someone else's problem and then they want to bark at them when they don't live up to their expectations or blame their government for not doing something to make their life easier. All this would go away if people would get their priorities straight, take care of their own and quit looking for a scapegoat.
5
That's a lovely sentiment but not everyone has a family. For those that do, not every family is in a financial position where one full-bodied adult can stay at home 24/7 and feed, diaper, and bathe a disabled person. Or two. Or four, depending on the number of parents. For those that have the family and the financial resources, not everyone is physically capable of this labor, their houses are not wheelchair accessible, and it is not safe to have a person with advanced dementia or alzheimers in a normal home with access to knifes, hot stoves, scissors, shoelaces, or children. Open up your eyes and your heart to the realities of the world you live in.
30
Not everyone has family to care for them.
3
Profit motive + healthcare = oil + water.
11
This is going to happen to millions of people, thanks to Trump and the Republicans.
7
History will not judge the United States by our military might, but by how we treat the most vulnerable among us.
13
Thanks Republicans. What happened to making America great again? The GOP spends its time taking millions from the NRA in order to protect the right of terrorists and the mentally unstable to have assault weapons that can kill dozens of children, while they do nothi g to help the millions of Americans without basic health insurance
8
With the republican cuts coming to all social programs, including Social Security, Medicare, and Medicaid, everyone should expect to be paying more and more and more, and if you used all the loopholes to save grandma's assets from paying for the nursing home bill you're soon to get some bad bad news.
5
This has been going on for a long time. Medicare will pay as long as the patient is improving. Once the care is determined to be palliative the patient does not qualify for Medicare and needs to move to a different facility based on their ability to pay.
This is a problem that will get worse as baby boomers age. This slow moving train wreck is part of the overall problem with healthcare that is too expensive and poor quality (given the measured results) compared with other industrialized countries. But the reckoning is coming.
16
Our top notch health care system at work for itself only. America is no place for anyone in danger of contracting a serious illness, anyone who is not rich enough to pay for the care she needs, or anyone who is not able to fight for he needs or get someone to fight for him.
We don't have a health care system in America. We have a wealth care system. The ACA should have been a single payer universal access health care system. One of the largest problems people over the age of 50 face when they lose their jobs is finding new ones. This is due, in part to our idiotic approach to health care. No one, ill or healthy, should have to worry that if they aren't rich they will go bankrupt paying for the care they need or be thrown out of a facility because said facility no longer wants them because they can bring in a patient who will pay.
If being healthy is so vital, why is this country sticking to a health care model that doesn't work? Why is America willing to sacrifice the health and well being of its citizens to satisfy the health care industry? Answer: the same reason our lawmakers don't want to deal with gun safety, campaign contributions. The almighty campaign contribution and power associated with winning is more important than our health or lives. We will all die but can't we at least be treated with some decency and humanity while we're alive in this country? Is that too much to expect after we pay our taxes?
44
After a stay in a nursing home, 30 days only I would prefer to have 'the black pill' left on the kitchen table. I choose to die on my terms no one else's. My kids know this is my final decision followed by cremation.
9
The black pill is my plan too. "Opioids for the Elderly"
3
Left out of this article is the very important distinction of whether Ms. Zwaschka-Blansfield was in a for-profit or not-for-profit facility. It sounds like she was in a for-profit, where the emphasis is always on the bottom line.
This should be a lesson to all who seek a placement for themselves or a loved one. Do your research, and consider a nonprofit placement if at all possible. Find out what their mission is. ASK the question: What happens when I run out of money? For some, the answer will be: we have a foundation that will continue to subsidize you. For others, the answer may be: our state has a program that you can apply for (such as Wisconsin's Family Care) to help subsidize your remaining years. They may help you with information about the Aid and Assistance Veterans benefit, that so few people take advantage of. In other words, a nonprofit will do its best to help you and make sure you never have to worry. The resident always comes first. But a for profit is always looking at the bottom line, and residents are as important as cash flow. Their common room may be prettier, but their residents are happier.
8
More and more nursing homes have become for-profit. Greedy entrepreneurs know that by serving inedible food and limiting the number/quality of caregiving staff, they can get rich. The pity is that Americans don't wake up to the problem until they become vulnerable and need care themselves. Then it is often too late.
9
More than two thirds of the nursing homes in this country are for-profit--many in large chains and/or with extremely opaque ownership structures.
8
Good grief. "Trump has scaled back the fines against nursing home that harm individuals, in keeping with the administration's broader deregulation push." Once again Trump has done something to make the rich richer while making the elderly, the sick, the disabled, and the poor suffer more.
Notice how Trump's deregulation always hits the most vulnerable the hardest? Coal companies in poverty stricken Appalachia can dump waste in rivers again. Newly opened uranium mines in formerly protected areas can let their radioactive waste blow over the Navajo Reservation. And disabled and sick people can be mistreated at nursing homes because Trump has lowered fines. America has turned into a hell of a place to be sick, old, or poor.
53
I would like to know, did the nursing home have a social worker and a PT to work with the patient to help her obtain mobility and independence? Does Medicare arrange for follow up home visits. No one should be told on day 100, you have to leave. There should be a series of steps, and people need to understand the process. Most amputees should be able to go home.
13
??? Why is there even an appeal process if the facility isn't required to take the person back in again? The former resident is left no better off than they started out when they filed the claim!
Oh, and:
The administration "has scaled back the use of fines against nursing homes that harm individuals, in keeping with the administration’s broader deregulation push"
In keeping with the desires of big Trump funders like the owners of these nursing home corporations, more like. Just as with every other piece of deregulation, you can bet someone with a lot of money is going to benefit.
33
The situation with homeless patients is really sad because they have nowhere to live once the nursing home discharges them. However, nursing homes are not residences, and if someone no longer needs inpatient medical care, then the nursing home may need that bed for a patient who does need medical care. It's heartbreaking to discharge a homeless person into a shelter, but I also think that nursing homes cannot act like hotels or shelters, because they are a medical facility that cost much more money to run since they have to be staffed with nurses and doctors and medical equipment.
7
I wish there were more information on this lady's living situation prior to the amputation. While nursing home residents are entitled to a "safe and secure" discharge under federal regulation and discharge to a homeless shelter really cannot be termed "safe and secure," a person with an amputation, absent other factors medically qualifying them for nursing home care, may potentially safely return home.
HOWEVER, this presumes that the person receives adequate services at home: home health, physical therapy etc. deficiencies in in-home services are also another glaring weakness in our "system" of care. A person may very well have been receiving Medicare benefits and/or other health insurance benefits while in the nursing home, but, even with an appropriate discharge, not be able to afford the type of services needed at home. Medicaid home and community based services may help but if the person is just above Medicaid eligibility there will be no government-paid in-home services. Even middle class people find paying for such services difficult and, in the long term, impossible.
The "system" of long term facility care and long term services and supports in the community has been frayed for a long time. At least nursing homes are both federally- and state-regulated. The Feds do not regulate assisted living communities; any regulation is done by the states. And home and community based services? Often like the Wild, Wild West.
4
This gets to the heart of the question we must ask about all of health care: Is it a business first or is it a system that cares for all those in our society. All private entities will prioritize profit and this goal, throughout health care, leads to compromises in patient care. We do not have unlimited funds, obviously, so hard decisions must be made. But these decisions should ethically made, considering economics, outcomes, compassion and societal benefits. Allowing thousands of organizations to navigate the conflicts of interest at the expense of patients creates chaos. National standards, guidelines and enforcement are required.
19
Medicare pays for medical care. Not custodial care. When the clinical benefit of one’s hospitalization (including post-acute care in a skilled nursing facility or rehab hospital) ends then so does the coverage of that care from Medicare. This is not new. This is how it has always been.
If you need custodial care then it’s on your dime. Some people have private insurance that covers nursing home care but that is very rare. Most people that must live in a nursing home environment because of their condition but do t have insurance and can’t afford it out of pocket, must become Medicaid eligible by ridding themselves of all cash and possessions. THEN, they can qualify for Medicaid funded nursing home care. Again, this is not new.
This woman’s situation is not new nor unique. This happens hundreds, if not thousands, of times every day and those of us with aging parents have already dealt with the challenges associated with similar situations.
There are no easy answers.
35
Short of being discharged, the nursing homes will move a resident to a "custodial care" floor or wing when their payer status changes, where they will often be placed in rooms with up to five other residents and the nurse-to-resident ratio drops to an even more appalling level than in the Medicare units.
Nursing home care in this country is a scandalous byproduct of the notion that health care should be run like any other business.
The US media will never tell you the truth about this: citizens of other developed countries look upon us with disdain when they learn the gruesome details about US health care.
48
Why do you state that the US media will never tell the truth about this situation? Isn't the NYT part of the US media and are you not commenting on such a report? I have become accustomed to the president-lite disparaging the "media" at any and every possible opportunity, but as a reader of many sources of news, I am completely aware that the profit-driven health care system here is causing these problems. I suggest that instead of alleging that there is no reporting, try to avoid using such broad condemnation of all news media, since it is objectively not correct.
2
Welcome to the America of Trump McConnell, and Ryan. Let's all pitch in and make America mean and cruel again.
61
This has all preceded Trump. He just becomes the convenient face of "mean and cruel." Wake up.
3
This has precisely nothing to do with Trump, McConnell, and Ryan. But why waste my breath?
7
Nice try but this is not new. This has been the state of post-acute care for decades. No one - not Reagan or Bush(s) or Clinton or your Messiah Obama did anything to fix this. Probably because I’m there is no easy answer.
6
Dear Forgotten Men and Women,
FORGET YOU!!
Very Truly Yours,
Donald J Trump
22
My Mom is 98 years old and on the "high-care" floor of an assisted living facility. She's blind, mostly deaf....but still walking unaided and fairly aware. (Although they keep her very medicated so she's groggy.)
One day I noticed her tennis shoes were bloody at the toes. I took off her shoes and socks, and her toenails had grown so long they were slicing her open. (Sorry for the gruesome visual.)
Someone helps her dress every day, but no one noticed this or bothered to do something about it. This is the level of care you get in this country for $3,500 a month.
78
She is very fortunate to have a daughter who visits! I have found that without a relative or friend to advocate patients in hospitals and any other institutionalize doctor care are treated as if they all had dementia no matter their age or mental acuity or indeed wealth.
29
She's my best friend, even if she doesn't always know who I am.
11
And we have legislators who think that needing to pay for someone to cut an elderly person's toenails is a waste of money. Why? Because everyone can cut their own toenails of course. God only knows what they'd've done if she'd gotten an infection as result of their neglect: probably blamed her for not saying anything.
3
I am so very glad and thankful that my mom lived in Canada and had excellent care in a nursing home in Toronto, Ontario. My mom had dementia. She had her own room and shared a bathroom with the lady in the adjacent room. Unfortunately she slapped the lady in the adjacent room in the face and had to be moved to another room where she had her own bathroom and no access to the adjacent room. My family had to pay only $1200.00 a month and the rest was paid by the government. According to their law, if a demented person in a nursing home presents a thread to another resident in he facility the demented person has to be moved to a private room with a private bathroom at no extra cost to the family. Americans may complain and talk about the Canadian healthcare system however, their system to my mind is superior to what we have here in the US. I am lucky enough to still have family in Canada and therefore, if I am ever in need of care in a nursing home I will definetly consider moving back to Canada. I will be more than happy to spend my hard earned money there than here.
59
Wait a minute. Where does the Canadian government get the funds to provide the subsidized nursing home care? I'm assuming from taxes.
So you are going to live and work in the US (because I'm assuming the job opportunities are either more plentiful or offer pay better), pay no taxes in Canada during your working life and then move to Canada when you need subsidized health care?
You are shirking your responsibility to contribute to the system you are relying on to serve you in your old age. This is gaming a system for personal benefit.
And we wonder why He-Who-Must-Not-Be-Named found enough like minded voters to put him in office.
6
I'm glad your mother received the care she needed but I have an issue with your statement, "if I am ever in need of care in a nursing home I will definitely consider moving back to Canada". Really? Canada isn't good enough for you now, but when needed you'll take advantage of our system even though you haven't been paying taxes to the Canadian Gov. Sure, I have no problem supporting you in your later years. No wonder our system is broken.
5
I worked in Ontario in my profession for a number of years and contributed to the Canadian pension fund and old age pension fund. I have an Canadian bank account and enough money to pay for nursing care in a nursing home in Canada. I would never expect Canada to pay for my care however, by the same token, would certainly not refuse a little financial help”.
Hey, never fear, I am sure one of the billionaires who got all that money back with the tax cut, will read this article, and will help out their fellow citizen. I am sure it will trickle down to her any day now.
but I wouldn't hold my breath waiting.
36
We need assisted dying. And a way to pre-plan to refuse care if we’re unconscious or unable to speak.
16
A few years ago, most of the poor and elderly in my state only had enough insurance to recover at the nursing home for 21 days. After three weeks, the patient and family needed to make outrageous weekly payments. There were state programs to cover some of the costs, but not much. Most went home too early and relied on family caregivers. However, I always wondered what happened to those without that option. I assumed they went back to the hospitals where they received the amputations or hip replacements surgeries, etc. It never occurred to me they may have been placed in homeless shelters, though.
10
You can tell a lot about a country by how they treat their children, elderly, and disabled citizens. FDR gave us social security and pensions while LBJ gave us Medicare and Medicaid and later Clinton gave us the CHIPs program. Now we're actively cutting these programs and forcing our most vulnerable to fend for themselves. Nice country we've become.
71
And Obama gave us the ACA and DACA..both under siege.
8
This is no surprise to those of us in the field. I am a healthcare attorney and have seen first hand the way the elderly are treated in this country. Our government is charged with oversight of the providers of nursing home care but for many reasons the government fails to provide oversight on even a basic level. As a society, we have no use for the elderly and are dismissive and indifferent to their lives and it plays out every day in so many ways especially in care settings. For sure there are some very good nursing homes and some very good staff taking care of patients. They are the exception though and not the rule. It is criminal what happens and we should be deeply ashamed. We are not.
59
Nearly ten years after a bailout of the financial sector we are told that austerity is needed. Here is the result. Both parties fund the Pentagon more than it needs. Here is the result
42
This country is just an abject disgrace. There is no other way to put it.
79
And Immigrants' Rights advocates want to bring in everyone who wants to come believing that Hollywood knows best. The countries that offer humane care at public cost have a clear rationale for the numbers who drink at the public trough. There is something seriously wrong with Open Borders while we cannot govern ourselves intelligently enough to meet the needs of our own people.
6
Yet republicans can find a trillion dollars to stuff down the pants of their richest supporters. We are a morally bankrupt country
129
As long healthcare remains for profit, greediness will eventually overcome what may have begun as good intentions. Will it take the elderly committing suicide to get attention? It's taking the murder of children to bring attention to guns.
33
Please get out the vote for this November. Knock on your neighbors' doors, and go to red districts on knock on those doors too. Also remember that homeless US citizens have a right to vote. Help them get get registered and to their voting districts.
42
The photograph of Ms. Zwaschka-Blansfield at the top of this article is revealing, and her concerns about a homeless shelter are probably justified. In her journey to recovery, she is just beginning to learn about 'amputation schadenfreud': a sociopathic condition where someone takes pleasure in another's misfortune.
While a nursing home employs trained nursing staff who are subject to State licensing boards, a homeless shelter does not. This makes the homeless shelter a magnet for sociopaths. In terms of amputation schadenfreud, these are people who obtain gratification by controlling the amputee if they are in a position of control over someone who is physical or psychologically vulnerable. It is not believed that, as a group, these people specifically target amputees as, say, someone with a foot, limp or amputation fetish might. Rather, the amputee is merely a target of convenience, and others - who might also be considered less powerful as them - are potential victims as well.
To make matters worse, homeless shelters often use a prison trusty system, where staff delegates jobs to other shelter clients...often with little or no supervision. Thus, the leg amputee must negotiate with fellow clients for food and other essential services.
17
Why does it cost $500.00 per day to be in a nursing home? Why would Medicare pay $500.00 per day. Just because a nursing home bills $500.00 per day is no reason for Medicare to reimburse the nursing home at that rate. The whole system is a giant con game including the new tax system which in order to enrich the 1% will bankrupt this country with $1trillion per year deficits. Each party is as corrupt as the other. There is no choice. The fix is in. That this sort of thing can go on while the military gets $600 Billion per year to waste on some nuclear air craft carrier while an amputee is referred to a homeless shelter is just one example of the slow decline of the American empire.
42
One party advocates for expanding healthcare access to more people, tax fairness, and less military spending. The other party advocates for less government spending on healthcare, tax cuts for the rich, and more military spending. I do not see the parties as equally culpable in the plight of elderly Americans seeking medical care.
28
We are circling the drain.
11
Perhaps I don't understand everything that a nursing home covers, but I volunteer at one. I have a hard time believing they spend $200, let alone $500 a day on most residents. I think there are one or two nurses on staff, then the rest are poorly paid aids. The rooms are all doubles and all very dated. Amenities are limited and food doesn't look all that great. I think the staff is caring, but the wages for nursing home workers in my state are on par with hotel housekeeping. A hotel in my city averages under $100 a night. A days worth of meals, maybe $60? Obviously, there is more care involved, but most of the residents don't need constant care. It seems like in many cases, it would be more efficient to rent people an apartment and hire personal assistants for them. You can rent a 2 bedroom apartment for $1200 a month, hire 3 fulltime workers for $90,000 a year (if full time care is needed), add in another $20,000 for food and other consumables. That's about $125,000 a year. You could easily have a second person in that scenario, lowering the cost to $72,000 per patient or $197 a day. Does a nursing home include the cost of medications in the daily rate or something?
16
Keep voting Republican, West Virginia and all you other distressed states. It's just a matter of time before entire towns are left homeless, but for the elected officials.
31
The plight of those who, for whatever reason, have not "aged well" here in Tax Dodge Nation is dire. I predict we'll soon see a sea-change in attitudes about assisted suicide.
14
My dad was in Assisted Living for the last 9 months of his life. It cost about $10K a month. In addition we had to provide for care 24/7 which meant that we paid for someone to be with him from 7 pm to 7 am 7 days a week, at $30 an hour. Luckily he could afford it. But we all need to rethink this. I for one, have no interest in living if I don't know who my loved ones are, are too sick to get out of my bed. We all need to think about this. And there isn't enough money in the US Treasury to pay my dad's bills for millions of people.
37
It would have been cheaper to add a room on your house and keep him there.
4
There likely is ENOUGH money. We need to get away from that perception.
We just need to stop spending millions of dollars a day on war and military skirmishes with no goals and no end. My father used to work in the aerospace defense industry: one stealth B-2 bomber costs $1 BILLION to manufacture. That was the cost a decade ago: it's probably gone up since then. (For contrast, I am a geriatric medicine doctor so am familiar with the costs of care.)
Poorer countries than the US provide universal healthcare including nursing home care to their citizens. Saw it in action in Canada; the elderly in many first world countries do not worry about who will take care of them in the same way Americans do. Americans need to get their priorities straight and vote for politicians who serve their interests well rather than lining their own pockets.
16
How anyone could think we live in the “world’s greatest country” at this point is beyond me. We live in a society of widespread alienation, division, selfishness, and moral bankruptcy. We are far from greatness or even plain old great. For those who will say “try living elsewhere and then you’ll see”, well, I have. Three years I spent outside our country, in Latin America and Europe. Instead of opening my eyes to how “great” we are, the experience opened them to how “not so great after all” we are. And really, could there be any question of how not great we are after electing Trump?
187
I agree, Moe. The U.S looks mighty different from the outside. My daughter lives with her husband and children on an Air Force base in South Korea, and she feels safer there, in the current hot zone of nuclear anxiety, than she feels in the U.S. We are much less “great” than we used to be, but most Americans have no idea, blinded by an ignorant nationalism.
2
“We have met the enemy and he is us”
What has happened to our country? We are barbarians.
95
Recall the two original sins: (1) Exterminating the native Americans who were here first and forcing the survivors from productive land onto desert reservations (2) Capturing slaves in West Africa and keeping them enslaved for a century or more
A good start, no?
35
Sarah said it. But there is still hope. America can and must change. It is never too late.
Thanks, Phil.
4
Pretty soon there will be no funds for medicaid nursing home coverage under the Republican/Trump budget plan. Depressed white people in rust belt states want their grandmothers kicked out of nursing homes, that is what they voted for.
60
I assume you realize that Florida's electoral votes all went to Trump, that Senator Rubio is from Florida, and that Governor of Florida Rick Scott was up to his eyebrows in charges of Medicare and Medicaid fraud, not that it hurt his political career there. Alas, many states, too many, went for republicans, and we need to work where we are rather than assuming the problem is elsewhere. All hands on deck.
40
You are correct although I didn't vote for any of those clowns. So retired people in Florida also want to be on the streets, that is what they are voting for.
3
It is reassuring to know that money is more important to nursing home operators than the health and welfare of their patients. What a system??
19
That's what happens when medicine and insurance became profit centers. Remember when Blue Cross was nonprofit?
22
I remember; Blue Cross was excellent insurance. It was a fine employer, too, my aunt ran a claims department (staffed, of course, with wonderful black American women) for the entire duration of a long career that began in her twenties.
When she retired, she received a pension, that with her savings allowed her to move to a small apartment in Leisure World, and into a nursing home for her last six months.
Those days are gone, into the pockets of the insurance and assisted living and nursing home corporations--and most likely, into their executives pockets. Now the game is get the money of the elderly as fast as you can, overmedicate them into senile dementia, and throw them out to fend for themselves.
5
America can find billions of dollars to support 5,500 military bases over the world, spend millions per day on aircraft carriers, yet cannot seem to find the money to support old Americans.
117
Don't forget first class travel for high level appointees!
37
Yes, especially weekly trips for our dear leader to Mar-A-Lago.
31
Don't forget the planned military parade. Millions of dollars for a few hours of pomp to scratch the itching ego of the Draft-Dodger-in-Chief
10
This is just so sad. We as a country and as Americans can do better than this.
21
In a society there are social services, or should be.
Now that the oligarchs have siphoned off 98% of the wealth of our country for themselves, and Trump just made sure they pay even less Taxes, things will have to change.
You lay in the gutter. They pass by overhead in their private jet. You drink polluted water from their factory. They drink Dom Perignon. The air you need will be contaminated (so the Vulture capitalists can have more money). The air is their garbage can now, (We didn't need those job killing, clean air regulations) Trump made sure of that.
Healthcare ? What is this, Socialism ????
Don't touch my billions.
By the way, have your sons and daughters sign up in the military, I need fodder to protect my investments. Oh! don't ask my kid to serve. He has a bone spur.
135
Sad commentary on American life if we can't give our elderly, who have worked hard all their lives, some dignity in their old age.
47
And paid taxes all these years. Some have also served in the defense forces. Nice way to show appreciation.
13
My mother was in a nursing home years ago. Over the course of several years, it took every penny she had. Then, she went on Medicaid for a year. Then, she died. She wasn't any sicker - she just received greatly reduced care. They fed her food she couldn't really eat, and she choked to death. There is a reason why patients don't live very long on Medicaid in nursing homes.
The same people who refuse to allow abortion and euthanasia are the ones who want the 99% to suffer and die in misery. Go figure.
132
Because abortion isn't really "pro-life"- it's pro-controlling women. They don't care at all about what becomes of a fetus after it is born. The hypocrisy is mind-boggling.
43
The *only* way this will change is to take the profit out of the human misery servicing industry.
30
It will never happen. Even if you cut costs by 90%, 2/3 the country could never afford it anyway. Most people cannot run their own lives day to day.
9
Speak for yourself, MM. Our land is full of decent, hard-working people, some of whom give far more than they receive, some are heroic, many love others. I'm tired of the sour back-biting and jeers that seem habitual with such as you. Look around and see the people who deserve your kindness or even appreciation. If you can't see them, I'm sorry for you.
36
Everyone wants free stuff.
How about the third option.
Go live with children or relatives.
14
Free stuff after paying taxes their entire life. And you want people to stop working to take care of their aged parents, who will support the people who stop working to do that care?
32
Children and relatives are not often qualified to provide care, and if they "give up" their jobs to care for relatives, who can pay the bills today let alone tomorrow?
41
Survival of the fittest for old and sick people. What if there are no children or relatives who can do skilled nursing care. But the billionaires need their tax cuts.
41
My mother who is in her 80's, fell 2 years ago. She was sent to a nursing home that Medicare paid for. She still needed to stay beyond that she was covered. Her bill for 1 month of care, $10,000. She is fortunate enough to be able to cover that cost. Many are not.
32
My mom had dementia, my dad Alzheimer's, I am a nurse and an attorney. Medicare, supplemental parts A&B, as well as traditional insurance for those under 65 May cover nursing home coverage for 1 month post hospitalization in an acute care hospital or not. After that, it is either private pay, including prepaid long term care insurance or Medicaid which is coverage for the poor. Currently each state administers its own Medicaid payments and has different guidelines. Nursing home care is what is called chronic care with no real expectation of cure or recovery, it is the physical bathing, diapering, feeding, turning and monitoring of the impaired and it is mostly done by unlicensed assistants who are paid poorly. These patients generally require 24 hour a day care, some with Alzheimer's or other neurodegenerative diseases may require care for 7-10 years. My mom died 4 years ago, at that time a bed in a double room cost about $1,100/month or $130,000/year. Reputable Nursing Homes have a ratio of private pay beds to Medicaid beds and generally if you can private pay for a year or two they will keep you when you qualify for Medicaid. You qualify for Medicaid when you have spent down to a total of about $2,000 total assets and all of your social security and pension payments go to the Nursing Home. If there is a spouse still alive, he is allowed to keep the home and 1car as well as about $2000/month. All of this varies by state.
Baby boomers need to plan wisely.
90
Dorothy G: I know it is very possible to make typos in a post, but I want to clarify -- MEDICARE pays for 100 days PER YEAR per patient after hospitalization -- not one month (30 days) -- 100 days. It could be all at once or spread out over several hospitalizations. This is confusing to patients and family, as the patient may be in and out for several hospitalizations -- but in one calendar year, they ONLY get 100 days TOTAL. (It is easy to lose track of this, when dealing with a sick frail family member.)
Also: $1,100 a month must be wrong -- I assume you left off a zero! it's more like $11,000 a month and that won't get you top care, but as you say a shared room with a lack of staffing, often places that are dirty and neglectful. But that's all that Medicaid will pay for -- once you have used up 100% of your assets.
As you say, SOME nursing homes -- even some AL homes -- will let you stay on as a Medicaid patient IF you have been a private pay patient for years -- but you cannot count on this. Many facilities told me UP FRONT that you have to leave in 30 days if you run out of money, and go to a Medicaid facility. That means for many patients giving up a nice private room or even suite, to go into a shared roommate situation in a much less nice facility.
It is wise to know this in advance!!! for yourself or family!
10
As a baby boomer (1957) this ATM is tapped out. I supported my aging parents who were WW 2 refugees and didn't have much of a nest egg accumulated for old age and on the other side I'm helping my children with their college debt. My long term plan is to eat poorly and stop exercising so I can die of a heart attack before what little funds I have run out.
11
During the life cycle, men and women are most vulnerable and in need of support by society when they are young and when they are old.
Most of our real estate taxes support the schools which prepare the young people for life. In addition to actual schooling, this often entails sports and other less expensive extras.
It seems to me that those of us who are older and who have paid real estate taxes as well as social security and medicare taxes all our lives should be entitled to the same consideration as youth. Society accepts responsibility for one across the board, society should also should not put limitations on care for the other.
Perhaps the time has come to go back to mandatory Bible reading in schools. It is pretty clear the churches have lost sight of the Good Book.
9
So you are blaming school kids for Trump cutting the taxes of billionaires. Sure, let's scapegoat the kids who gave absolutely nothing to do with Medicare and Medicaid.
20
Huh? What does the Bible have to do with anything, other than to point out the hypocrisy of the GOP, many of whom identify as "Christian." This administration in particular seems very keen on discarding the sick, the old and the poor in America. I do not call that patriotism or Christian values.
10
What good does reading fairy tales do?
4
Many commentors are confusing Medicare with Medicaid. Medicare has never paid for long-term care except in very limited circumstances. Longevity was not a big issue back in 1965, when the majority of seniors died within 10 yrs of retirement age. Medicaid is the program that pays for 80% of nursing care residents. If the GOP gets their way and changes to block grants, you will see the problems get WORSE, not better. Block grants were used before, and were a terrible way to spend federal tax dollars. They were replaced by matching funds (with minimum basic standards established) for a reason - look it up, folks.
55
I see empathetic capitalist commentors are here. 'Pay for you own care!'
My father required memory care during the last 6 months of his life (he was violent and outweighed me -- I could not care for him). He had paid for long-term care insurance for 20 years. When it came down for the insurance company to pay, they refused, saying he did not qualify for care. Fortunately for him we, his adult children, were able to fight them, but it required intervention with the insurance commission of the state of Virginia. He would not have been cognitively able to do this. My dad did the 'right thing' by buying insurance, but it still took until after his death for the insurance company to be forced to pay. We, as citizens, can do the 'right thing' all we want, but when deep-pocketed companies overrule, little can be done.
A society is judged by how it treats its most vulnerable people.
261
Just one more knife in the back for old people like me. They want to take away my Medicare, my painkillers, my lodging, etc. Perhaps George Orwell had the right idea in "1984"........do away with old people.
78
Give the GOP time. I fear they're working hard at it.
23
Its not just the GOP. Give the partisan hackery a rest.
1
The GOP is continually making attempts to reduce the social safety net. The Dems are not. This is a fact. And facts matter, even in the Age of Trump.
13
From first hand experiences through a loved one, I am certain when I say that if any institutions need to be regulated better by our states and the feds they are nursing homes (SNF's), and that includes our assisted living and memory care facilities.
For the most part, these establishments are for-profit. As a former hospital nurse, I can assure these readers that "for-profit" more times than not means substandard care and unfair treatment.
I will not mention the names, but currently there are numerous law suits, including class action ones, in California. They are from tip-to-tip, San Diego to Eureka. Unfair evictions, negligent care, injuries, sometimes downright filth, low-paying "caregivers", inept "caregivers". The list goes on.
We need to become advocates for the vulnerable in our society, the aged, the chronically ill, the physically and mentally disabled. Too often these individuals have no one to stand up for them, and they can not do it alone.
110
TO be an advocate for the most vulnerable, you need to also be an advocate for the second-most vulnerable in this picture, the o low-wage direct caregiver, who you for some reason enclose in quotation marks. Direct care is a fast growing employment segment, where demand exceeds supply and yet jobs go unfilled, or are filled in cases by persons unsuited to the job. I believe there is a reason for this. The powers that be don't need to compete for employees because they know the low-wage, low-skilled worker is trapped, and they are indifferent to the impact this has on residents, who are not seen as people but as revenue generators. Add to this that caregivers are more often than not women, and women of color at that, and on that basis alone are likely to be underpaid.
The Ryan Congress contemplates cutting Medicaid, and one can only imagine how much more these vulnerable populations, both the served and the ones who serve will be affected. Operators will respond with the bottom line as their foremost worry. A sane marginal tax rate, say 50%, including the AMT, and a minimum wage that is also a living wage, is the only humane solution. I also happen to believe it is doable.
33
This injustice has to stop we need the nursing homes to stop doing this and govt regulators medicaide and Medicare are their for persons to use this way of paying that's what they paid into so all should be aware that maybe you might be in the position in the future of being kicked out themselves in a nursing home. So to the grown ups who regulate these programs investigate this injustice and save our elderly from being evicted
8
In California there is a program called The Light for Seniors, inc National Care Planning Council. For a modest fee they will help seniors who are having difficulty paying for nursing home and medical services.
My in laws used their services when my father in law become too ill and mentally unfit to live on his own. He was in his late 70s, was estranged from his family, had no savings, no credit cards and no assets. My mother in law may be next in line, due to poor lifestyle choices, rapidly diminishing physical and mental capabilities.
Thank heavens most of my elderly and disabled family members live in Europe where they enjoy national health benefits, reduced cost meds and support services. My sibling and I plan on moving there for our golden years. Our mother keeps telling us how grateful she is for making the move back to Europe after 30 years in the US. She is really enjoying her retirement reconnecting with childhood friends, traveling and focusing on her health rather than her health care bills. With a little bit of planning and research you too can enjoy your retirement years so long as you are prepared to move overseas.
26
Nice for you and your family members. But not an option for most. The vast number of American have no ties to a European country that would permit them to live off their social welfare system.
12
The process is not as difficult as you think. You figure out what country you want to move to, how long it takes to establish residency (1 year) and apply for citizenship (2-5 years). So long has you have assets/savings, monthly income, and are prepared to pass a language test (verbal and written) you are welcomed with open arms. You get credit for paying taxes in both countries. Your money has to stay in the USA because of US regulatory requirements and laws. So you have to find a bank that has international branches. The citizen requirements vary depending on the country. It is sometimes easier if you can prove your grandparents lived in the old country. There are lots of little towns in Europe trying to repopulate their dying communities with foreigners with money.
2
One answer, which nobody likes to suggest, is for people to save their money in order to pay these expenses. Also, long-term care insurance is available (before you need the benefits). Do people raise their children to help pay these costs for their parents when the parents get older? It's so easy to say the government (taxpayers) should pay for everything, but is there personal responsibility for anything?
By the way, Medicaid is still available to pay, but then these people have to accept the facilities that accept Medicaid. So, it is not as if there is nothing for people who can't afford to pay anything themselves (or who are unwilling to use their savings). Can't always get Rolls Royce facilities for Yugo prices.
16
If you make $30,000 or less per year, how on earth can you save enough to pay for nursing home care, which easily costs $10,000 per year and which can be required for a decade or more?
Are you saying that some of us deserve Rolls Royce care? Are you really saying that some of us deserve Yugo care? Do you have any idea what Yugo care is in a nursing home?
24
Do you have any idea what the daily cost is for nursing home care if one does not have insurance or when it runs out ? In NY is it about $460 per DAY.
That only covers the room and board, not the medical care.
Assisted living is not covered under Medicare, that is purely out of pocket and in NY runs about $3500 - $5000 per month, depending upon the facility. Care is provided on an a la carte basis, which dramatically increases the monthly payment. A nursing home is the next step once a certain threshold of care is required.
Not everyone is able to save enough for their future care. It is extremely costly. And by the way, Medicaid is not always easy to get, nor is it easy to get placement in a facility that accepts Medicaid. Medicaid does not allow any assets above $14,800, anything above that has to be spend down.
35
You want personal responsibility, Tony? Clean the bathrooms and floors you use, kill and clean the chickens you eat, make and transport the clothes you wear, cook and serve and wash your own restaurant dishes. Or pay enough for the hard working people who cushion your life every day enough to live on and save. You will come to your own need soon enough, and I hope those humble people who will lift and turn you and see to your bathroom needs are kinder than you are yourself.
31
Since when did it become the nursing home owners responsibility to pay for the poor's care. Do their costs go down because grandpa ran out of money? No. If society thinks this is important then they should pay for it (higher taxes), if not grandpa needs to go elsewhere or his family need to come up with the difference. This may sound heartless but if we are a capitalist system then that's the way it goes. We don't tell other businesses they have to sell their products or services for less why is it okay to tell a nursing home.
14
Assuming that this is a "for profit" nursing home, we don't know what their business model is. What exactly are their costs? What is their total revenue and what is the mix (Medicare vs. Medicaid)? How much profit are they netting? How much is being spent for salaries of their exectutives? Do any of their overhead costs seem inflated? Are there any contracts with subcontractors that appear unreasonably high? There's a lot more that we would need to understand so we could accurately answer these questions. At first blush however, I don't think we can assume that the "nursing home owner is being made to pay for the poor's care".
17
Do we ask your proposed questions of other businesses? Maybe food would be cheaper is Safeway had different suppliers, spent less on their executives etc. If the nursing home owner isn't paying for the poor's care (for residents that can longer pay full price) then who do you think is paying? He/she isn't writing a check of course but they are earning less what is the same thing.
1
Thank you, Mary.
It is critical to get one's facts correct here. Nursing homes are not being forced to pay for the care provided to poor people. However, if they wish to be licensed under Medicaid, they are required to abide by those rules (to the extent that the rules are enforced, which is, generally speaking, not very much).
As the article notes, the rules include safeguards to protect residents from simply being unceremoniously ejected from a facility when their form of payment changes (or is likely to change, or if the facility finds someone who will pay more for the bed, etc...).
Nursing homes are not required to participate in Medicaid or Medicare. While the U.S. is not a capitalist system, the nursing home industry has no shortage of opportunities to capitalize on Medicaid and Medicare reimbursement policies (too often at the expense of resident safety and dignity).
26
Governments: state and federal need to get more involved in patient care and the assessment of nursing facilities or thin will get much, much worse for our aging population. Most nursing home residents are at the last stages of life, or in very precarious situations. They have little recourse in defending themselves. They need our protections.
30
I don't believe these people were gettting the type of long term care the very frail get at the end of life, which is not covered by Medicare.
I believe they were in for "short-term rehab," which is covered on a imited bases by Medicare and is intended to get people back on their feet after illness or injury. The maximum number of days of these coverage is 100 under tradtional Medicare. But if people get their Medicare benefits through an HMO-type "Medicare Advantage" plan, then the plan, not Medicare, calls the shots, and these plans generally want people out of both hospitals and rehab much earlier than traditional Medicare woud require.
I do not understand why people in their 50s are on Medicare. Perhaps they have qualified for Social Security disability benefits. that is the only reason I can think of someone in their 50s would be on Medicare.
8
Personally, given the percentage of my income I pay in taxes to both state and federal governments, I think I would like my money used where it helps the weakest among us. I do not care what these people "qualify" for under the programs discussed; Medicare, Medicaid. Mediwhatever...they should be able to get the care they need to heal and become productive citizens.
11
Usually people in their 50's are NOT on Medicare. If they are, there might be some extenuating circumstances which necessitated or allowed them to be on Medicare...yes, such as disability. Medicare generally starts at age 65.
Its about time the gov't look into this and stop. Too often people are prey to established businesses that represent themselves as honorable. They basically take what they can, and then dump the person. Often without doing what they needed to do.
Another reason why we need a healthcare system along the lines of Germany.
17
You don't want the government to look into this.Given how compassionate our Congress is they will cut off all help and support so everyone can be sent to a homeless shelter.
4
good point - they would give them a gun and send them off on the street.
1
The reality is that nursing homes can't be forced to take care of people who don't pay. If nursing homes are banned from evicting people, they will figure how to not accept patients who are likely to not pay the bills. If more and more regulations come into play that try to force the nursing homes into caring for non-paying residents, the nursing homes will simply close their doors. New York Times readers (and authors!) shouldn't be shocked that nursing homes insist on getting paid: these same New York Times readers wouldn't show up for work themselves if there weren't a paycheck at the end of the week.
19
My aunt's AL home -- in 2013, when she was admitted -- rigorously investigated her finances, with a very long form I had to fill out -- proving she had the assets to pay her bills there at least for several years. She was 91 at the time.
They told me that they did NOT take Medicaid, so if she ran out of money -- she would have 30 days to leave. The Medicaid nursing homes around here are third rate, have shared rooms and no private bathroom -- and are in poor, shabby neighborhoods.
Fortunately, she passed after 2.5 years there, so she did not run out of funds, but I can easily see how that happens. The costs are obscene for the quality of care given....the facilities usually have awful food, low levels of staff and general neglect. Even at the prettiest "chandelier" buildings, you see people in wheelchairs, staring blankly at a TV most of the day.
Nursing homes could not stay in business if forced to take non-paying patients -- in fact, NO BUSINESS COULD -- not hospitals, not doctors, not dentists -- not ANY BUSINESS can survive without income.
While there are abuses and gross overcharging, in fact this is difficult and unpleasant work and nobody is going to do it "free" as a charity.
8
Who not paying here? These facilities simply receive a lower reimbursement from Medicaid. These facilities are actually braking the law when they force these patients out in violation of their licencing obligations. The problem is slack enforcement. The only people taking advantage here are the operators of these facilities and the government authorities failing to serve the public.
8
This government has made it impossible for people to have care come into their home, which is far cheaper than nursing home care.
2
I have seen this problem with my own eyes. Since Medicare covers only a limited number of weeks, people who cannot care for themselves are sent home where the sleep in their feces, get infections and die.
A related problem is that younger people without full health coverage don't get cancer screenings, and then find out they have cancer too late, so they die early of what might have been prevented.
The NY Times is filled with articles about what will happen in the future if we continue running deficits, often in a highly partisan debate.
But liberals in particular seem to believe that there are no limits to resources. How else could they make California into a sanctuary state.
The Immigration Reform Act of 1986 was supposed to end illegal immigration. it didn't because many people simply defied the law.
Since 1986, the US population has increased by 85 million or over 35 per cent. The result is that resources have been shifted from universities to K12. Over the last 30 or so years, we have trained more unskilled workers and fewer doctors as a result. That explains why medical costs have skyrocketed. It explains why Obamacare leaves so many holes, why America cannot afford universal health care for its citizens.
We need a full discussion of the impact of population growth on inequity, on quality of life, on sustainability of the planet.
We need a stop to illegal immigration, but also a change to the welfare system which favors smaller families.
18
Reality check. Out population is rapidly aging. The demand for these very expensive services are increasing expedentially. Without robust immigration their will not be enough workers to support the growing percentage of retirees. Everyone's standard of living will suffer if we reduce this vital source of young workers.
12
Nursing homes need a lot tighter regulation. The owner of the nursing home in Miami where 11 people died after hurricane Irma already had a history of Medicaid and Medicare fraud, yet he was still collecting from the government with apparently no problem.
The owners of these nursing homes usually live in large mansions. It's not that they are not paid enough to provide care, it's that they are keeping too much for their own greedy profit.
36
Not getting paid-->financial failure-->closing of the home
The bad guys here are the payers.
Same in medicine, where I work. Family practices are closing right and left because of flat revenue and increasing costs. The increasing costs are generally caused by government mandates.
If you fill your schedule with Medicaid pts you are essentially working for free.
10
Preying on the elderly who are not going to have the resources - financial, logistical, intellectual, physical - to successfully advocate for themselves.
Doesn't say much about these homes, but also doesn't say much about American society either.
22
This is a sad, sad story. I know we shouldn't base public policy on anecdotes, but it looks like this is a crisis for our elderly.
How about it, President Trump and Mr Ryan? Do something about this mess?
6
You left out the most important aspect of the story. How many of these facilities are owned by Wall Street-type venture capital funds? I read here in the Times that they're snapping nursing homes up, bundling them into chains, and milking the profits. They should be exposed and shamed. Why are nursing homes even operated as profit-making businesses? Health care is a human right, not a profit-making commodity. Step one is to turn all nursing homes into non-profit entities where any money made after reasonable and well-regulated salaries are paid is reinvested into the facility and its patients. Capitalism and profit are the number one plague affecting American healthcare. When will we wake up to this glaring fact and get the capitalist out of our health care? If Europe can do it, we certainly can.
87
Excellent point! The Guardian has had several articles on the profiteering shenanigans in the UK sometimes lead by US private equity firms. A few of the articles below.
https://www.theguardian.com/news/2017/nov/08/private-equity-terra-firma-...
https://www.theguardian.com/business/2011/nov/14/care-home-administratio...
https://www.theguardian.com/society/2012/dec/01/care-homes-watchdog-fina...
12
One small point. Nursing homes utilize their own doctors who "have privileges" and decide who must go and can stay. I stayed for one week post joint replacement surgery in a Rehab wing of a nursing home (a lucrative addition to many n.h.'s willing to spend some investment money on high level physical therapy equipment) and had an unexpected complication from surgery. I had to find transport to my surgeon's office because he was not allowed to see his post-surgery patients at the n.h. The in-house doc did a cursory eval of me and told me to see my surgeon at his office. I got a ride from a relative to my surgeon and return to n.h. Totally crazy.
26
How much of this is a consequence of a culture that celebrates outsourcing our children and parents, rather than taking care of our families?
12
John - I take care of my mother. I am not young. It is physically and emotionally difficult. My mother is demanding and abusive. I would encourage her to go to a home if there were a decent one that we could afford.
41
Outsourcing my kids and parents??? What country do you live in? I haven't gotten a raise of more than 1% in five years. I have to work as does my husband. If I stay home to take care of the kids, are you going to subsidize my family for lost wages? Doubtful. Our parents are living longer (which I hope not to given what Paul Ryan is getting ready to do to Social Security and Medicare in 2019) and therefore need more care, full time care. Again, should I stay home to do that? If so, are you going to subsidize my family for lost wages? Again, doubtful. No one celebrates having to use a nursing home or day care. We do it because of necessity. Eyes wide open friend, eyes wide open.
47
VB, I live in the People's Republic of California, where even with our relatively adequate teacher's salaries, it was much more affordable for my wife to stay home with the kids than it was for her to teach. We did the math, and after taxes, day care, car payments and eating out because of the workload imposed during the school year, we realized that we'd break even with one of us staying home instead of working.
11
The problem is that our health care system in the US is broken. Every American should have free health care, but it will never happen, as long as drug companies, insurance companies and financial institutions dictate our health coverage. Those "wealthy and powerful for profit institutions" own our federally paid employees through large donations to their campaigns or through bribery and kick backs.
We cannot expect a nursing home to provide quality care for little or no payment. Instead of blaming the nursing homes, why not direct your attention to the true culprits - the heath industry as a whole.
Better yet - hold your state Representatives and Senators accountable for the massive failing of health care in the US. Threatened with a loss of their job, it might help them to see the larger picture a little more clearly.
38
Valerie:
News flash. There is no such thing as "free" health care. Someone has to pay for it.
1
Anita, pretending to fail to understand Valerie's meaning doesn't help. Other nations provide health care at half our costs with better outcomes. And yes, of course it's paid for through taxes. Yet the people there are certainly not envying us for our for-profit hell or clamoring to emulate us. I'd be delighted to give up my share in the 1.5 TRILLION dollar tax cuts ahead in order to spend that tax cut where it's needed most, for our nation's needs, these our most pressing needs.
9
Anita--
RE: "There is no such thing as "free" health care. Someone has to pay for it."
Absolutely true--rather like the misnamed "free" essential health benefits in the ACA, where there is no extra out-of-pocket and the insurance companies figure the cost of the essential health benefits into the premiums they charge.
We need to have discussions about how to make the system equitable. That may mean *I* pay more because I've been blest with resources & education/problem-solving skills to figure out a plan for me, and it may mean that I pay more in taxes or ??? so that my bit is pooled with the contributions of many others to pay for those less blest than I am. I can't pay for all those less blest by myself, but the greatest nation in the world we should be able to figure out how to make it work so that "the least of these" among us are treated with dignity & compassion...not kicked to the curb.
2
Individuals who use up their Medicare coverage for skilled nursing care obviously do not have the assets to continue paying out of pocket (which they would have to do until they exhaust their assets). They therefore qualify for Medicaid. This article dovetails with a related story in The NYT last July (https://www.nytimes.com/2017/07/21/your-money/estate-planning/the-ethics... where older adults legally shield most of their assets so they can qualify for Medicaid. But they should know that the lower reimbursement assures that they will end up in the worst of the skilled care facilities. The immoral reality is, you get what you can pay for in health care just like any other product or service which is not the case in many other democracies.
High quality health care is more and more a privilege of the wealthy.
64
Something this story isn't about, but that is also in play in numerous states is the nursing home lobbying not just of individual legislators, but of judges. A former judge in Arkansas is currently in Federal prison for accepting wrongful contributions from nursing home owners. Arbitration clauses that prevent residents from legal action are another issue. The reality is that nursing home residents who find themselves being cut off from necessary services are often fighting a much more extensive - and corrupted - system than they are aware of.
46
This is tragic. We all, especially those in power, will be judged by how we treat those who need help and are not able to defend themselves or hire expensive advocates to lobby Congress for their cause.
12
The article only addresses half the story. It does not describe the issue of economics and costs, which are crucial to the story.
Nursing home care is expensive, and nursing homes are usually businesses. They cost a lot of money to operate, mostly for employee salaries. They are generally not “high profit.” Someone has to pay these costs. If homes provide care for which they are not reimbursed, they will not be able to pay for their workers; care providers must be on site 24 x 7 x 365. If the bills are not paid, most homes would likely go bankrupt, and would not be available for any of us.
Regulators set standards for nursing homes; this is a good thing, but the standards are expensive to meet.
Medicare does not pay for most nursing home care; that’s the way it is. Medicaid often does pay, but only for minimal care. The rest must be paid by the patients, out of pocket. Some people purchase long term care insurance before they need care, to help cover the cost. This insurance is expensive, and today only provides limited coverage benefits.
People are living longer, which is generally a good thing. But, as we grow older, we need more care, and we need it 24 x 7 x 365. Folks with diseases like Alzheimer’s require even more care.
Who is to provide this care, where will it be provided, and how will it be paid for? These are major unanswered questions all of us face, and which society has not yet answered.
53
If the nursing home agrees to take on a patient, then it needs to provide the appropriate care for as long as the patient requires it whether the payment comes from Medicare or Medicaid. The problem seems to me that nursing homes are happy to take a patient who is receiving Medicare — even when they can reasonably anticipate that the patient will require care after Medicare benefits are exhausted, and anticipate kicking the patient out when Medicare benefits end. The patients don’t know this and therefore cannot chose a different facility or even plan in advance for the discharge.
14
A nursing home rehab facility shouldn't accept a patient it doesnt think it can care for -- whether the level of care required or for the time that will be necessary. And some places do this -- they simply won't accept the patient, and I have seen this.
A problem arises with patients who are on these Medicare Advantage plans. They often decide they want to end care well before traditional Medicare would have ended it.( Many, if not most, lower income people are on Medicare Advantage plans.) I think sometimes the rehab place doesn't know in advance when the Advantage plan is going to want the patient out.
2
My aunt had a Medicare Advantage plan that my cousin thought worked well 'til my aunt was diagnosed with stage 4 ovarian cancer at 89. She went to a rehab facility from the hospital--even though we knew she would be going home to hospice--because we needed time to get hospice set up & my cousin who lived with her needed to make a number of arrangements.
Where traditional Medicare paid for 100 days for my mother after her hospitalization (even though with her Alzheimer's we knew she wasn't coming home), the Medicare Advantage was harping at my cousin to get her mother out of the facility after just ten days. Somehow it was extended out to a total of fourteen days--and she/we really wanted her to be home, anyway--they even came to the house to inspect before we brought my aunt home, implying they would contact the Division of Aging about elder neglect. The whole Medicare Advantage program was awful at a time when it was needed most.
3
It's expensive to die in the US. My recently passed mother went through about $500K of her savings the last four years of her life in assisted living and using private aides. She had excellent care but had the resources for it.
She was on hospice once for about six weeks but then it was rescinded by the doctor b/c her weight was stable. Her second hospice lasted only about a week before her end.
I read in the Guardian last year that in Great Britian the government decided that after approximately $90K was spent by the patient or family on long term private care the government would step in and cover costs. I have no idea how that can be afforded here if we want to maintain permanent low level wars.
89
Never the less, our wise Congress and President, saved the 1%er's from the dreaded death tax.
23
The NHS in Britain in falling apart and on the verge of collapse. Read The Guardian this year.
4
Mainly because the Tories want it to collapse,their real agenda is to privatise it. Countries like Germany and France where privatisation is not supported have a lot fewer problems.
2
We have a lot of really bad nursing homes. We also have some good ones , and a lot in the middle. I fully understand that this is a business - but a business that deals with life or death issues, for people who are in no position to wage a fight, must to be tightly regulated. The penalties for exposing patients to risks have to be severe to mean anything - and there has to be more than a remote chance of being caught if regulations are to matter. Fines have to be high, and there must be the option of jail time for those who are repeat or severe offenders. We would take it seriously if there was direct action to end someone's life or cause injury: this is a form of inflicting the same damage without actually touching the person. The owners must suffer the consequences themselves. And nothing positive will develop during this Presidency, under this Congress. We cannot, you see, afford it.
25
This has been and continues to be a travesty. Elder folks who have saved all their lives will see their money run out in short order in an Assisted Living facility. They were very expensive 10 years ago when my dad lived there; can't imagine the cost today. His money lasted 5 years and gracefully died right before I would have had to transfer him to a Medicaid facility. All that money that he had specified for his grandchildren's college educations down the hole.
Medicaid facilities, exactly because payment to them is so low, are dismal, depressing, unsafe places in many (not all) many instances.
Why does building a wall, buying the newest and fanciest weaponry for our military, cutting taxes for rich people and corporations, take precedence over actual help for tax-paying and poor citizens?
293
You state that "All that money that he had specified for his grandchildren's college educations down the hole." The hole his money went down was the hole that was providing his care. I don't understand why that is not considered good use of his savings. I am all for the government supporting those who do not have the funds to pay for their own care but, I don't know why tax payers should pay for your father's care just so that his own money can instead be left for his grandchildren.
19
Medical care, in a hospital or a nursing home, is a sucking hole because the consumer has no protection against inadequate care and gross overcharging for what patients receive. As in any other for profit business, so much management effort goes into increasing profits, so little effort goes into the final product. You may find yourself in a hospital or care facility one day, and you will wonder, how can so little care, inattention to your medical needs, surly nurses, terrible food, cost SO MUCH?
15
Well, to start with, poor citizens don't pay taxes. Second, poor people have already been living off the public trough for most of their lives.
2
Culling the herd. And how many of the people being evicted, and their families, voted GOP ? SAD.
64
Why is a 50-something year old woman receiving Medicare? And don't flame me but is her condition due to diabetes due to her weight? At some point people need to take care of themselves. If this is the case, then her health issues are totally avoidable, or were.
18
She is on Medicare because she is disabled. About a quarter of Medicare recipients are on Medicare because of disability, not age.
29
Too bad her "sin" is visible, so she's open to criticisms of people who disapprove of others. If she was a life-long smoker, an alcoholic, a drug-abuser, a worn-out athlete, or genetically unlucky, she might escape your critical eye.
14
Your comment, jumping to conclusions about Ms. Z-Blansfield's health problems, isn't adding anything to this discussion. I have an acquaintance whose entire leg was amputated due to an invasive cancer up by his hip. No matter how Americans end up depending on Medicaid or Medicare, telling them to hop down the road to the nearest shelter is not any kind of solution at all.
19
Any society is judged by how it treats its sick, elderly and invalid.
This is just unconscionable on so many levels, but so is the reaction by society as a whole. ( let alone the government ) If you cannot pay, then that is the bottom line. It does not matter if you paid taxes your entire life. It does not matter if you are a decorated veteran. It does not matter if you can pay quite a lot ( $200 a day is still quite a lot )
I understand there are many costs to rehabilitation and the like but still. $500 a day to care for anyone is the real injustice that we are not talking about. ( especially since this administration has prioritized giving tax cuts to corporations and billions over taking care the sick and the elderly )
Unconscionable.
103
Or like my grandmother, who had excellent health care + personal savings; the nursing home wouldn't let her go, so one Sunday, we picked her up for an outing and never took her back... They wanted to drain her of all her money after her Medicare ran out... Another con/despicable practice...
160
As an estate and probate attorney, I worked with many nursing homes. Many of the staff and administrators were professional and competent. But some were greedy, rude and ignorant and that was a growing trend. Everyone who works in the nursing home gets the bottom line and every patient is at the mercy of it. I would work myself to death caring for a parent at home before I would leave them in an assisted living or nursing home.
73
"Some were greedy, rude ..." SBC, you've got that right. A close friend has been dealing with the problem mentioned in this article for about six months, with a mid-80s parent. District of Columbia residents, the parent was hospitalized and then recommended for short-term physical therapy in Maryland (Maryland: note to those who think this kind of thing can only happen in "the red states"). Then the problems began. The parent has declined drastically, was not provided with much of the required therapy, etc. Involuntary discharge due to insufficient payment; Medicare stopped paying, etc.
This family is not affluent. But the adult child (another sibling takes little interest) has been hyper-involved. That in itself is not enough. The parent was transferred with no say in the matter to a second facility recently. This place is inferior to the first one, in my view; and the parent will not be permitted to stay there very long, either. I think the nursing home administrators are about 90 percent in the wrong, but that isn't of any help. My guess is that cases like this go on all across the country; but many people are not aware that things like this can happen.
17
Exploitation of the elderly is a national crisis. See, "The Takeover" in the New Yorker. But don't read it before bed, you won't be able to sleep.
8
So $6000 a month isn't enough? And Medicare pays $15000 a month? My Dad, who died back in 2011 was paying way less than that, way less. More like $3500 a month. Is Medical inflation really this bad? A person with $100,000 can only last a few months at this rate. Crazy. What about people who have nothing, which is most of the people? Something completely screwy here. I find it hard to believe that it is costing this kind of money except in extreme cases.
34
Hugh, I looked at AARP's long term care calculator and was astounded at the price difference between Louisiana and Montana! Currently the average price per month in LA is $5420 and in Montana it is $6646 per month. In Pennsylvania the average cost per month for nursing home care is $8425. Given that Tea Party and Freedom Caucus politicians want to decimate Medicaid and privatize Medicare, Baby Boomers who may need future nursing home care better wake up.
9
AMEN! My dad, who predeceased Mother, saw the potential trainwreck & had a long-term care plan in place that was one of the originals to get people into the system & those plans are no longer marketed--when she she died in 2011 the cost at a barebones facility here in the boonies of north Missouri was around $3200/month. She was physically healthy, and could have stayed in her own home, but had always been combative, that worsened with Alheimer's, we could find no one to help at home, & she refused to cooperate in home care, so upon hospitalization the DR said she must be placed in a geri-psych facility or we'd be reported to the state Division of Aging for elder neglect.
How is it that the greatest nation in the world can't figure this stuff out--we can build nukes & threaten the world but we can't protect kids in school or the elderly in nursing homes???
7
Believe it. Before my grandmother passed away last year she was in a memory care ward. Annual cost: $108,000. This was not the Ritz-Carlton either. The accommodations reminded me a lot of my first college dorm room.
It was not the cheapest place around but we moved her twice to get her out of places that were neglectful and gave shoddy care. Even if you are paying "only" $6,500/month you expect not to worry about basic care. But, no. We would show up and find her parked in a wheelchair in a corridor with no one around. We spent thousands of dollars on hearing aids; most days the staff wouldn't bother to put them in. Per the state care standards these things shouldn't have happened. Didn't matter. The shoddy homes broke the law in a daily basis.
3
Time for one national healthcare plan and one level of payment.
64
Consumers must educate themselves about the differences between Medicare and Medicaid. I know so many people who say, "Medicare will pay to keep me in a nursing home." Wrong!!! There is a long list of 'if- thens' to get Medicare to pay for a short rehab stay. Long-term care in a skilled nursing facility, your responsibility until your assets are gone and then Medicaid kicks in. IF you meet their requirements. And IF our government doesn't make sweeping reductions to Medicaid funding.
62
Also it doesn’t always kick in, if you were in hospital under “observation” status, rather than “admitted.” I used to think they were being so careful, but really it was all about them abd their fear of a readmission within thirty days.
1
This situation is obscene. The care of the frail and elderly should not be a ‘business’. It should be a national commitment and a national source of pride. Many aren’t going to like this but I think the nursing home industry should be socialized. Take the profit out of it.
245
The congress can give massive tax cuts to corporations and the very rich. But they cannot find the money to make Medicare and/or Medicaid cover the elderly and helpless.
I guess that is what is Making America Great Again.
265
Your comment is right on. But "great" should be spelled "grate".......because that is exactly what is happening. I am 87 years old and I know whereof I speak....
1
Not to argue with the main point of the article. But nursing homes don't print money. If it costs $3000 a month and Medicare pays $3000 and Medicaid pays $1500 (examples only) the nursing home can't run on only Medicaid patients and will simply, but forcefully, close down.
13
This problem will only worsen. The aging of the US population is a huge train coming down the tracks and rather than devote the necessary resources, we have added 1.5 trillion to the deficit in the form of a huge tax cut for the wealthy.
133
If one considers that the Baby Boomer era started in 1946, there’s almost 75 million of them. They’re now in their early 70’s. That’s a lot of people to care for! And then you have to add those of the Greatest and Silent generations who are still alive (1.5 and 28 million more).
So you Gen X (51 million) and Millennials (75 million) have a lot to worry about having taking care of.
3
Not a sexy topic, and very few will read this, but I echo kathleen's conclusion that all of this squabbling and fretting over details of healthcare can be eliminated by adopting a straightforward, well-designed single-payer system. IT can save enough money in wasted administrative overhead (part of which is arguing over when a patient is rehabilitated) to fully cover long-term nursing home care. Urge your Congressional reps and everyone you know to support Improved Medicare for All, House Bill 676.
306
Single - payer health care systems in Europe do not routinely cover residential long-term care for the elderly. And there are many, many fewer nursing homes and assisted living facilities in Europe. The cost to the tax-payer would be prohibitive there, as it will be here. The elderly in Europe mostly cope on their own with greater family involvement.
1
I just wrote to Brad Wenstrup to support this bill. View it on the Countable app
It is my understanding that Medicare only pays for nursing home care when the patient is in a doctor-ordered rehabilitation program. Coverage for their rehabilitation stay is up to 100 days. Medicare coverage was never intended to cover long-term nursing home residential stays. Once the rehabilitation program ends most patients are eligible to return to their homes or to assisted living facilities. They are not routinely transferred to the long term nursing home portion of the facility unless they qualify for skilled nursing care.
24
If you can’t pay privately and you are not financially eligible for Medicaid, then you need to spend down to Medicaid eligibility. Medicaid eligibility rules for nursing home care vary by state. Not all require a need for skilled care. To be eligible for Medicaid nursing home coverage coverage you need to meet both the financial eligibility criteria and the nursing home level of care criteria—which vary by state. If not, you are out of luck. Welcome to the great American long-term care system.
50
Hi, Bill. It seems that perhaps you have not had to deal with an elderly parent who must rely on Medicare for their medical needs - the majority of nursing home patients are elderly. Many such patients have no home to return to, and cannot afford assisted living. This is the situation in America today for "the greatest generation". Additionally, it is common for patients to acquire secondary infections and conditions while in nursing homes - this leads to a cycle of hospitalization and return to the nursing home to start at square 1, which can easily eat up the 100 day limit for Medicare. We need to do better as a country - there really is no excuse for the way we treat the elderly in this country. I for one would gladly pay more in taxes for a single payer Medicare for all system.
196
The article should have drawn a clearer distinction between short-term rehabilitation and long-term care. Medicare pays for up to 100 days per year of the former, but not for long-term care. That's the way it was designed.
Long-term care is either private pay, perhaps assisted by a private insurance policy, or Medicaid, for the indigent.
The people cited in the article were on Medicare, meaning they were in rehabilitation, not in long-term care. Once rehabilitated, they either pull out their wallet or go on Medicaid, or go home under today's rules. It's a bait-and switch on the nursing home for a patient to come in the door for rehab and then insist on staying indefinitely for long-term care with no payment plan in place.
The nursing homes appear to be abiding by today's rules. I would favor changing the rules, but will Congress? BTW in Europe many countries insist that long-term care is legally a family responsibility, shared by children and grandchildren when mom and dad can't pay.
10
This problem has unfortunately been going on for a long time. I worked in a nursing home as a physical therapy aid over 30 years ago. The therapists were constantly struggling with administrators who wanted to dump patients as soon as their medicare ran out. Even if they were unsafe to go home and making progress in physical therapy they would get kicked out as soon as the reimbursement went down. The only hope was if the patient had smart and actively involved family to help them fight to stay. What's even sadder is that I've seen the kind of transformation, from helpless to functioning, that good rehabilitation can offer patients. But they need time in rehab. It all comes back to the fact that healthcare as a business model is not about patient needs. We need single payer healthcare for all!
365
You do realize that the realities of budgets and costs still apply in a single payer system, right? I work with a number of physicians in Europe who are constantly looking at their budgets when making treatment choices. And don't think that the government can be more efficient that the private sector...that is a sign of insanity.
2
Unless health care and nursing homes is completely nationalized, the fundamental structure of private business in a capitalistic society is profit first. Ranting about moral aspects of nursing home administrators is useless. They are just cogs in this entire system where they (also have family to feed, jobs to keep) have little control.
5
QED, what you say is nonsense. When it comes to health care, the government can indeed be more efficient than the private sector--if you measure "efficiency" not in terms of profit per patient, but in the rate of positive outcomes (which, in turn, are profitable to society as a whole in the long run).
Anecdotal evidence: A few years ago, my best friend here in Germany suffered a brain aneurysm in her late 40s. She could have died, but was lucky there is a specialized clinic only 5 minutes away across the border in Switzerland. The German public health care fund ("Krankenkasse") paid for her transportation to Switzerland, the operation by top specialists, more than a month in the ICU, and then rehabilitation for about 4 months at a top notch facility here in my town. She paid nothing for her operation, nothing for her rehabilitation, received a percentage of her salary for the whole time she was in treatment. And now? She is fully rehabilitated, working full-time and again a tax-paying contributor to society.
Do we pay a lot of taxes here in Germany? Sure. But I glad that the money is going to good things, rather than just the latest weaponry to blow up the world.
16
This has been an issue for a long time. Medicare covers Rehab or as it is known, a skilled nursing facility. But what happens if you keep getting sicker? It's a shuttle back and forth to and from the hospital. But the Medicare 90 day clock keeps running, and is often reached before the patient is "rehabilitated." The best option is home care, but that requires relatives to step up, since home care visits under hospice (which is covered by Medicare) are only a few hours a week. If you're not on hospice, figure a minimum of $3,000 per month for a group home, and $6,000 plus for assisted living. At least I was able to write off my sister's group home cost, but apparently that disappears under the new tax law.
93
Let me add one thing: Hospice is approved if a doctor says you have only six months to live, but since these things are not precise, it can be renewed by the doctor. While nurse and aide visits are only a few hours a week, oxygen, a hospital bed, and all of the consumables (bandages, prescriptions, etc. are covered. It can be the best option, but again, relatives need to step up, and this is a big deal if assistance is needed to feed, bathe, go to the bathroom.
36
And the question is, what if there are no relatives there to step up? (Which I assume is the case with Ms. Zwaschka-Blansfield, otherwise how could they even think of releasing her to a homeless shelter?) What happens to people who have no one to help or stand up for them? What happens to people whose relatives refuse to help, for whatever reasons? Are these people just put out on the curb and left to their own devices?
The American medical/health/patient care system is just rotten to the core.
6