Fear (Of The Unknown)
This week, we had a chief operating officer come in from a long term care facility in Massachusetts. What struck me the most about his presentation was the mentioning of block grants and how they could affect long term care facilities- particularly nursing homes.
Medicaid is the primary payer source for most certified nursing facility residents, with more than six in ten (63%) of residents having Medicaid as their primary payer in 2014 (Harrington, Carrillo & Garfield 2015, p. 1). The elderly and disabled account for one in four enrollees, but they account for two thirds of Medicaid costs. Living in a nursing home is expensive, which is why many residents have come to rely on Medicaid to cover their expenses. In fact, the average annual cost of care in the United States is $94,170 for a private room and $82,855 for a semi private room (PR Newswire, 2013). These suggested block grants would eliminate the financial protections and generate a (negative) change in the quality of care protections for the many residents living in long term care facilities. Even if states continue Medicaid coverage for nursing home facilities, there would be considerable changes as to who would be covered, how long would their coverage last and what type of care and services they would be receiving.
In the case of long term care facilities, they often get put on the back burner and since the baby boomer population is aging to the point where they will rely more on medical facilities and health care, this is a worrying reality that we might face. According to the AARP, the cost per elderly to Medicaid is likely to increase as the Boomer generation ages. This cost increase will likely occur faster than the per capita cap growth rate proposed by the AHCA will allow (Flinn & Houser, 2017). If block grants were to be successfully initated, there is a higher chance that long term care facilities would be forced to make cuts in their budget due to the lack of funding. As the COO mentioned, when you are forced to cut back on resources, this will dramatically decrease the quality and level of care they can provide to their patients.
It is unfortunate that long-term care facilities face the harsh reality of possible cuts from state funding if block grants were implemented into our healthcare. Not only does this impact the future of long-term care facilities, it also affects the residents because they won't be given the same level of care that they deserve. This affects me personally as my 91 year old grandmother is currently living in a nurisng home where she relies heavily on her aides to assist her with day to day tasks. The thought of her losing out on great quality of care because her facility had to cut back on labor costs is disconcerting.
Flinn, B., & Houser, A. (2017 June). Capped financing for medicaid does not account for the growing aging population. Retrieved from https://www.aarp.org/content/dam/aarp/ppi/2017/01/Capped-financing-for-Medicaid-Does-Not-Account-For-The-Growing-Aging-Population.pdf
Harrington, C., Carrillo, H., & Garfield, R. (2015 August). Nursing facilities, staffing, residents and facility deficiencies, 2009 through 2014. Retrieved from https://kaiserfamilyfoundation.files.wordpress.com/2015/08/8761-nursing-facilities-staffing-residents-and-facility-deficiencies.pdf
PR Newswire. (2013 July 30). John hancock national study finds long-term care costs continue to climb across all provider options. Retrieved from https://www.prnewswire.com/news-releases/john-hancock-national-study-finds-long-term-care-costs-continue-to-climb-across-all-provider-options-217586991.html
Medicaid is the primary payer source for most certified nursing facility residents, with more than six in ten (63%) of residents having Medicaid as their primary payer in 2014 (Harrington, Carrillo & Garfield 2015, p. 1). The elderly and disabled account for one in four enrollees, but they account for two thirds of Medicaid costs. Living in a nursing home is expensive, which is why many residents have come to rely on Medicaid to cover their expenses. In fact, the average annual cost of care in the United States is $94,170 for a private room and $82,855 for a semi private room (PR Newswire, 2013). These suggested block grants would eliminate the financial protections and generate a (negative) change in the quality of care protections for the many residents living in long term care facilities. Even if states continue Medicaid coverage for nursing home facilities, there would be considerable changes as to who would be covered, how long would their coverage last and what type of care and services they would be receiving.
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| Source: The Kaiser Family Foundation |
In the case of long term care facilities, they often get put on the back burner and since the baby boomer population is aging to the point where they will rely more on medical facilities and health care, this is a worrying reality that we might face. According to the AARP, the cost per elderly to Medicaid is likely to increase as the Boomer generation ages. This cost increase will likely occur faster than the per capita cap growth rate proposed by the AHCA will allow (Flinn & Houser, 2017). If block grants were to be successfully initated, there is a higher chance that long term care facilities would be forced to make cuts in their budget due to the lack of funding. As the COO mentioned, when you are forced to cut back on resources, this will dramatically decrease the quality and level of care they can provide to their patients.
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| Source: AARP Public Policy Institute |
Flinn, B., & Houser, A. (2017 June). Capped financing for medicaid does not account for the growing aging population. Retrieved from https://www.aarp.org/content/dam/aarp/ppi/2017/01/Capped-financing-for-Medicaid-Does-Not-Account-For-The-Growing-Aging-Population.pdf
Harrington, C., Carrillo, H., & Garfield, R. (2015 August). Nursing facilities, staffing, residents and facility deficiencies, 2009 through 2014. Retrieved from https://kaiserfamilyfoundation.files.wordpress.com/2015/08/8761-nursing-facilities-staffing-residents-and-facility-deficiencies.pdf
PR Newswire. (2013 July 30). John hancock national study finds long-term care costs continue to climb across all provider options. Retrieved from https://www.prnewswire.com/news-releases/john-hancock-national-study-finds-long-term-care-costs-continue-to-climb-across-all-provider-options-217586991.html
I actually don't know how to respond to this as I am just a frightened as you. My father is on dialysis and relies on Medicare for the high quality of care he receives. Most of the members of my family in my fathers generation have some form of long term chronic health issues (surprise, I live in the land of fried vegetables and gravy). The only thing I can think when these sorts of things are proposed is that those proposing them think somehow they are immune from the effects of these decisions. Hopefully, sense will prevail.
ReplyDeleteI am so sorry to hear that, and it is unfortunate that we (and everyone else in our position) are having to worry if the quality of care our family members are receiving now will change in a way that puts them at a disadvantage. I agree with you when you say those who are proposing this change think they are immune from the effects - considering a good chunk of Republicans are part of the Baby Boomer generation. I forgot to mention this earlier but in Alaska, Georgia, Louisiana, Mississippi and West Virginia; more than 70% of nursing home residents relied on Medicaid. To me, it seems quite ironic they are all Republican states, I wonder how those statistics will change if they implement block grants?
DeleteI live in Texas so, while I might not agree with the platform of the Republican Party, there are the prevailing group in charge. What I cannot understand is how they can persuade so many good people to act against their own interests (maybe that is why I am not a politician). We need conservationism as well as liberalism, working together we create better solutions but those solutions need to be ones that don't cause harm. It seems that we have turned a very dangerous corner and I know that I guilty as well. I don't always attempt to understand the other side and now we are paying the fiddlers bill for that attitude.
DeleteBTW I work for Texas Medicaid and I know that Texas is in the same boat as far as Nursing Home reimbursement. As older people are more likely to vote, hopefully our politicians will see that as a threat to their job security.
DeleteI think LTC facilities get put on the back burner because no one thinks they will need one, and if they do, someone else will just have to pay for it.
ReplyDeleteI think you hit the nail on the head with this.
DeleteIt is also concerning that by the time the younger generations get to a point where they will need LTC, social security may not be in existence and healthcare costs, presumably, will keep sky-rocketing. I had no idea that nursing homes were THAT expensive.
ReplyDeleteI had no idea either! I looked more into it and in Massachusetts, the median annual rate was $128,845 for a semi-private room and $139,580 for a private room- how absurd is that? In New Hampshire, the annual rate was $115,40 for semi and $122,275 for private. However, I doubt that a majority of the residents are paying that much out of pocket but to me, the rates seem a little overboard for what they're paying in a year.
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