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Understanding Medicaid and Long-Term Senior Care

In discussing nursing home neglect and abuse the phrase “profits over people” is often mentioned. This usually refers to cut corners, poor staffing levels, inadequate equipment, lack of training, and other decisions by facility administrators which harm residents in an effort to limit the resources going to actual care for those in the facility. Much of the work of elder care advocates and those fighting nursing home neglect is pressuring facilities to commit more resources to these efforts to better balance the owners quest for money and the resident’s need for quality services.

To best grasp this situation one must be familiar with most common ways that long-term care is financially supported. For the majority of residents, this means the Medicaid program. Recently, the Kaiser Foundation issued a brief that discusses the role of Medicaid in these affairs to lay the foundation for understanding decisions made by owners and operators.

The full report can be downloaded here.

Paying for the Nursing Home
Medicaid is a joint federal and state program to provide medical support for those with limited incomes. That means that part of its coverage is for seniors who need long-term support services (LTSS) but who do not have the money on their own to pay for it. Considering the relatively high costs of those services, many seniors fall into this category. That is particularly true as the years wear on. Some seniors are able to pay for care out of their savings at first, but when resources dry up, they eventually need Medicaid support.

Unlike Medicare, Medicaid coverage includes payment for LTSS for participants who have certain needs. Those special needs are usually classified as being unable to perform any “activities of daily living” (ADL) or “instrumental activities of daily living” (IADL) without assistance. This includes things like bathing, preparing food, using the restroom, or managing medication. In general, those who qualify either have physical limitations that make these tasks impossible or cognitive challenges (dementia, Alzheimer’s) that place them at risk of harm when left without support.

Medicaid steps in to help provide LTSS. In many cases that might mean enrollment in a nursing home. According to the report more than 60% of all residents in skilled nursing facilities are on Medicaid. Many other program recipients receive “at home” support in a form which allows them age in place.

The report offers a helpful chart that breaks down where money comes from for all LTSS–of which nursing home stays are only a part. In total, about $342 billion is spent on long-term support services in the U.S. each year. Of that total, about 41% is covered by Medicaid and another 20% is covered by Medicare. While Medicare does not cover extended care, it does provide payment for some brief follow-up services after a specific illness or injury that required a hospital stay. The remainders are paid by private insurance, out of pocket, or third parties. Taken together then, it is clear that public funds pay for the majority of care, both inside and outside the nursing home. That is why public agencies can play such a crucial role in ensuring proper standards are met.

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Chicago Senior May Be Example of Brutal Family Abuse