There has been a rise in at-home or “community” nursing care in recent months and years, as many patients have opted to receive care at home. Yet this has not been an easy option for everyone. In a recent case in New York, an elderly man who had been released from a hospital to go to a nursing home for rehabilitation had been down this road multiple times. And with time, he grew weaker and more prone to illness such that he would end up back in the hospital anyway. It was the wish of both he and his daughter who looked after his care for him to simply go home where he could be most comfortable in what would likely be his final days. Yet he essentially was not allowed to go home and was again pushed back to a nursing home after his latest stay at the hospital. This was the doing of the healthcare system.
The patient in this case qualified for both Medicare as well as Medicaid reimbursement, but services that provided in-home care would not take him on as a client because they did not see it as profitable. Hospitals in general often try to get patients out so space can be made for others. And hospices would not provide care with Medicaid funding, and only in limited circumstances under Medicare, thus simply making it difficult to put this man in a hospice. Nursing homes have been generally more than happy to take on such patients, though, even in situations where they are unable to provide the adequate level and quality of care.
Many of these homes, for example, are understaffed, which is a major problem we have discussed previously where the facility owners and managers try to clear overhead by reducing staff, and thus increase profitability at the expense of the well-being of their patient residents. As the New York Times has noted, these homes have been glad to charge “premium Medicare rates, ordering hours of physical therapy and other treatment that studies showed was often useless or harmful.” Interestingly, the nursing home where the man in this particular case resided made $682.48 per day from Medicare for its care of him.
A Common Problem
The problem faced by the elderly man, who has since passed away, has evidently been endemic to the healthcare system and has adversely affected so many patients and their loved ones all around the country. The Institute of Medicine issued a report titled “Dying in America” which examined how people are living to older ages and have required greater care from the system as a result. Yet the need for profitability has seeped into the decision-making when it comes to where patients should receive their care. Nursing homes have largely taken advantage of these situations both in terms of legitimate billings, as well as fraudulent billings for short-term rehabilitation patients to the tune of at least $1.5 billion in federal taxpayer money. Patients have bounced from hospital to nursing home as opposed to the comforts of their home where they would prefer, and likely should, receive at-home care. Such scenarios would occur if programs like Medicare and Medicaid could pay more for them, and if services were not so focused on which cases would profit them and which would not.
This story infuses the controversies over fraudulent billing practices, the greed for profit, and the disregard for the preferences of patients and their families as well as what might actually be best for them in practice. Perhaps eventually the system will reform to avoid such issues either through forcing nursing homes to perform better, through careful oversight of Medicare and Medicaid billings, or through simply deferring more to the wishes of patients.
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