Nursing homes going the way of the dinosaurs?


by Judy Kirkwood

What if after you researched and visited and agonized and finally placed your family member in a nursing home you realized someone was encouraging them to leave the nursing home? How frustrating is that?

Hello Medicare.

Regulations adopted by Medicare in October 2010 mandated that a patient or guardian be asked if they wanted to go back in the community every three months. But now the question has been reworded to more specifically suggest moving out, according to Paula Span in The New Old Age column that runs in The New York Times.

Asking the question has caused such anxiety and concern that federal officials are reducing the frequency of asking it from quarterly to annually if preferred. The nudge to keep seniors in the community is not a bad thing; as with so many governmental regulations, it’s the timing and execution. There is no finesse when it comes to Medicare involvement: when the question is asked of someone who fades in and out of reality with progressive dementia, for instance, the result may be outrage and paranoia toward a relative who is trying their best to see their loved one get comprehensive care.
Elder care and Medicaid

States have long been spending significant amounts of their Medicaid budgets on supporting seniors living in institutional care settings. A demonstration grant program was launched in 2007–called Money Follows the Person–which was designed to help states transition Medicaid beneficiaries in institutional care back to community-based settings.

Under the new health reform guidelines, this program was extended through 2016 and 43 states have received federal grant money to transition Medicaid beneficiaries back into the community or their homes. Paula Span cites a Kaiser Commission on Medicaid and the Uninsured survey as concluding that nearly 17,000 people have been moved out of nursing homes into community living situations.
The future of long-term care?

Span notes nursing home occupancy rates have been falling for the past twenty years. So, what will happen as nursing homes disappear? Will in-home care services, assisted living facilities and other types of community care be able to deliver the round the clock medical care that some elderly require? Or is that one of the problems that nursing home facilities created in the first place? With round the clock nursing care, more people were living longer, with less quality of life, costing families and the nation more money to keep them going.

Maybe lower-cost local assisted living is going to fuel a movement to raise the quality of life while living but not prolong it when it is bad. It could be good for those of us heading toward elder care housing. But try explaining that to a relative with dementia or Alzheimer’s.