by Bob O'Toole
The elections of 2002 are over...Thank God! During the campaigns around the country, candidates from both parties seemed to emphasize 2 main themes. Remarkably, both sides seemed to agree completely on both of these themes.
Theme number one was: "My opponent is a dirty rat", responded with dignity by the opponent who assured us that the other candidate was "lower than a skunk."
Theme number two was: "If I'm elected I'll help the elderly get better care" Only a cynic would think that making eldercare a priority had anything to do with the fact that older folks vote in much larger numbers than younger folks.
The following excerpt from US News sums up just how bad things are getting in the quality of eldercare, and how it will only get worse...despite those promises from the skunks and the rats.
"The current wrangling over the federal budget carries high stakes for the nation's 17,000 nursing homes, about two thirds of which are for-profit. The industry is just emerging from a period of intense woe in which three of the five major for- profit nursing home chains filed for bankruptcy, even as they were under pressure to improve the quality of care. A significant factor in the industry's downfall was severe cuts in Medicare spending that began taking their toll in 1998. Thanks in part to Congress's rolling back some of those cuts, most of the chains have recently emerged from bankruptcy. But that $1.8 billion giveback is due to expire soon, giving tremendous urgency to this year's budget battle.”
”There's a sad irony in the nursing-home industry's focus on Medicare, the nation's health insurance program for seniors. While only 10 percent to 15 percent of nursing home residents are Medicare patients, Medicare provides 25 percent of nursing home revenue. (Medicare typically pays only if a patient's stay follows a three-day hospitalization and then only for 100 days of care.) The bulk of nursing home patients are on Medicaid, the state-federal program for the poor.”
”This is a case of the few paying for the many. According to a recent industry study, Medicare payments earn homes a rich margin of more than 20 percent. But that profit is many nursing homes' lifeblood because Medicaid in most states doesn't pay enough to cover the costs of caring for the old, sick, and frail.”
”The situation is exacerbated by the fact that many middle-class people who could pay for their own nursing home care believe they should' t have to. Guided by aggressive estate-planning lawyers, aging parents shift assets to their heirs so the parents can go on Medicaid if long- term care proves necessary later on.”
Empty wallets. “The patients who do foot their own bills typically pay more than the Medicaid rate. Many become impoverished and eventually go on Medicaid. So far, few people have bought long-term-care insurance, so the roster of private payers hasn't increased much as a result. And nursing homes have seen private-pay revenue dry up because of another trend: the boom in assisted-living facilities that lure seniors who might otherwise have opted for a nursing home.”
”State governments are under intense budget pressure because of the recent recession, and fast-growing Medicaid costs are often their second-largest expense after education. Indiana actually cut its Medicaid rates to nursing homes recently, and many other states are considering cuts or freezes.”
”Now the Bush administration has intensified the competition by suggesting that any Medicare increases for one provider group be balanced by reductions for another. The early bets are that doctors, howling from a recent Medicare rate cut, will get their wish--at the expense of hospitals. But the 900-pound gorilla dominating Medicare talks this year is the desire of politicians to give seniors an expensive new benefit--prescription drug coverage.”
Quality control. “Of course, poor patient care, from bedsores to sexual abuse, has long harmed the industry's reputation. The federal government Just unveiled information on individual nursing homes nationwide. (See related article in this issue of Elder Life Planning News) that measure, among other things, the percentage of patients with weight loss, pain, and bedsores. "Some nursing homes are a little flipped out" by the initiative, says CMS's Scully. ‘But many in the industry are convinced they need quality improvement to get sympathy from Washington and state capitals.’"
”No matter the outcome of the current Medicare debate, the financial health of the industry remains precarious. ‘Long-term care needs a long-term solution,’ says Robert Kane, a gerontologist at the Minnesota School of Public Health. ‘Right now we are keeping the bus rolling with spit and bailing wire.’"
Editors Note: Owning a private Long Term Care Insurance Policy can make a dramatic difference in your quality of life when the time comes when you need care. To learn more about avoiding dependence on your spouse or children, protecting your assets while avoiding the "Medicaid Planning" trap, and making sure you get to choose to stay at home when you need care, visit our on line "Consumer's Guide to Long Term Care". Just click on the link at our home page at http://www.elderlifeplanning.com.
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