The medicaid safety net pays for long-term care for the elderly.
Donna Nickerson spent her last working year as director of social services at a nursing home in trlock, California.
But when she suffers from alzheimer’s and needs to take care of herself, she and her husband can’t afford it: the bed in a nearby home costs thousands of dollars a month.
“I’m not a rich man,” said MEL, Nixon’s husband, professor stanislaus, a retired California state university. “I can’t pay for that.”
About half of today’s over-65s need daily help because they grow old at home or in a nursing home. The average cost of such long-term care is $91,100 for men and twice as much for women because they live longer.
In California and across the United States, many residents can’t afford it, so they switch to medicaid, the U.S. public-health insurance program for low-income americans. As a result, medicaid has become a safety net for millions of people who find themselves unable to pay for a nursing home bed or home care worker. This includes middle-class americans who often have to spend or transfer their assets to qualify for medicaid.
Medicaid, known in California as medi-cal, never intended to provide long-term care for everyone. It now pays nearly 40% of the country’s long-term care costs, and that proportion is growing. As the baby boom ages, medicare spending on long-term care is expected to increase significantly – by nearly 50 percent by 2026.
As people age, the pressure only intensifies, so state and federal officials are scrambling to rein in spending.
State medicaid director Matt Salo, said state medicaid directors are paying close attention to, because long-term health care spending accounts for most of the budget, and other plans.
“Not one day they didn’t consider long-term care,” salo says. “It’s a big part of the overall budget, and it’s growing… This is absolutely not sustainable.”
Meanwhile, people who need long-term care are running out of savings or transferring their assets to others so they can qualify for medicaid. Long-term care rates are rising, and many seniors find they can no longer buy insurance policies they bought long ago.
In California, where older people earn less than $16,395, they usually qualify for medi-cal. To get long-term care through medi-cal, they must also demonstrate the need for certain “daily activities” such as dressing or bathing. If older people can prove medical needs and spend most of their savings, and impose some exemptions on housing and other assets, incomes could be higher.
According to the U.S. national health service, about 21 percent of the state’s population over the age of 65 is medi-cal. Recent data show medi-cal has paid for the long-term care costs of about 716,000 elderly, blind or disabled people in 2013. In 2014, nearly a quarter of medi-cal spent on long-term care – about $14.7 billion, according to the California health care foundation.
Heidi DE Marco/Kaiser health news.
When he realized that the beds were too expensive, 85-year-old Nixon sought guidance from a lawyer who helped him take his wife’s name away from home and put out his name. Then Nickerson applied for medi-cal and helped her get into the Turlock nursing home where she once worked.
Now, nexen says he paid $1,700 a month from her social security, and medi-cal picks up the remaining labels, he says. Nixon said his 84-year-old wife is getting the care she needs, and he can’t imagine having her anywhere else.
“It’s definitely her best place,” he said. “She needs help 24 hours a day.”
However, if like Nickersons middle-class californians to seek the aid of medi-cal, so the plan might be overwhelmed, unable to help the people who need help the most, LeoneAge Joanne Handy California’s chief executive, said the plan on behalf of the nonprofit nursing home organization.
“The pressure on medicaid, not only in California, but across the country, is going up, up,” she said. “If you pay more and more attention to the consumption of californians we call middle income, and then enter medi-cal, it’s just a crazy policy.”
American of the national association of medicaid, director of the coalition, said people should not for their own economic difficulties to pay medical bills for a long time, but the country can’t provide care for those who each need medical service, how to control spending.
More than a dozen states, including California, are signing contracts with management care companies to provide medical care and long-term care to medicaid beneficiaries. The scope of these services can range from nursing home care to home assistance in bathing, housework and transportation to medical appointments.
Countries wishing to sign contracts with management health plans will help save money, improve care and better coordinate the services of the elderly. However, some health advocates said managed care – traditionally only provide medical care – doesn’t always prepared to offer other forms of care, such as bathing or cooking, and may eventually limited service or provider to save money.
California collects payments from people’s heritage to recoup some of the money it spends on nursing homes and other services.
Jennifer Kent, director of the state’s health care service, said: “we can’t have both – as a payer of last resort, let people keep their assets.”
This year, the state held an information hearing in Sacramento to brainstorm other ways to address long-term care costs in California. “It’s all medical aid, it’s a problem,” said senator carole lau, a state senator.
Some organizations, including the SCAN foundation, the city institute and the policy center, have been trying to come up with possible solutions. These could include new insurance schemes that would reduce the burden of medicaid.
Some 1.4m people across the country are in nursing homes, and about 62% of them are paid for by medicaid.
This ratio is even higher in the SAN fernando valley, in Los Angeles, where about 85% of the beds are paid by medi-cal. The chief executive, Molly forster, said some residents “can afford to take care of every penny they can”.
Sitting in the courtyard of a nursing home, Josephine rudolph, 99, said she had been helped in dressing and bathing. Rudolph, who still likes reading, says medi-cal has paid for her stay at home since 2005. Otherwise, she says, she can’t afford it.
Josephine rudolph, 99, said she couldn’t live in the technical care center at Joyce Eisenberg Keefer medical center in Reseda, calif., without medi-cal’s help.
Heidi DE Marco/Kaiser health news.
Herb and Judie Schwartz, 80, also rely on medi-cal to live in jewish families. Family photos cover their walls. An oxygen tank and a walker sit in the corner. Above the bed is an emergency label that notifies the nurse’s workstation if it needs help.
About four years ago, when they moved to the jewish home, Herb Schwartz, a former computer programmer, fell down, and the couple was no longer safe at home.
“Without medi-cal, I don’t know where we’re going,” says Judie Schwartz, a retired teacher. “We may end up with one of our children, I like them, but I can’t imagine living with them.”
The story was made by Kaiser health news, which released the California Healthline, a service from the California health care foundation.