Assisted-living homes are rejecting Medicaid and evicting seniors

hawkdon

hawkdon

Well-known Member
Location
Liberty MO
This is a bad situation, that is likely to get worse for seniors

Shirley Holtz, 91, used a walker to get around. She had dementia and was enrolled in hospice care. Despite her age and infirmity, Holtz was evicted from the assisted-living facility she called home for four years because she relied on government health insurance for low-income seniors.

https://news.yahoo.com/assisted-living-homes-rejecting-medicaid-112231372.html
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don
 

Medicaid is forcing recipients into Managed Care programs, which pays much less to doctors and other care providers. Recipients with certain chronic medical issues can opt out for 1 year but have no choice after that.

I believe Medicare will be switching to managed care as well.

Managed care also doesn't usually cover *expensive* treatments, imaging, and medications. IMO, managed care will hold back progress in the medical field.
 
They will end up in nursing home the government will pay for at a larger amount. These assisted living places are big money makers.

It's getting worse for seniors and everyone. I'm even afraid to ask for repairs in this apartment with these new shark owners. They are obviously max profit. So I'm doing without a dishwasher since it went out weeks ago.
 

Here they even kick out seniors from nursing homes for refugees only for profit.
https://www.focus.de/panorama/plaet...echtlinge-mehr-geld-bringen_id_186945741.html
"In Berlin, 110 residents of a nursing home for the elderly were unexpectedly dismissed. The operator and landlord are church institutions belonging to the Berlin Diakonie. What is so piquant is that refugees are now being housed in the building, which is much more lucrative than care for the elderly because of public subsidies." (Quote from the article, translated by deepl.com)
 
Medicare and Medicaid are becoming increasingly financially stressed with each passing year. Health care costs are soaring, and the number of elderly is increasing. The cost of moving to a good senior care facility can be thousands of dollars per month. About the Only way to keep these costs manageable is to take out a good Long Term Care insurance policy....in the younger/working years when the premiums are still affordable. Those having to rely on Medicaid often find themselves living in a very "minimal" environment.
 
I didn't realize that Assisted Living homes took MedicAid at all; I don't think they ever have here in this state but maybe that's because it doesn't really use MedicAid but something called MediCal. And just about the only thing Medi-Cal pays for is Skilled Nursing Facilities.
 
Do assisted living facilities have to have state accreditation? If that were the case then a state could mandate that to be accredited they would have to provide some number of medicaid beds. I don't look for that to happen though, but I increasingly feel that I'm part of the throw-away group of people in this country. I've watched more than a few people I've known that had significant resources wind up on medicaid with one major medical problem that required long term care.
 
I would like to ask if the participants in this very important discussion could please specify when they are posting, if they are referring to any or all of the following:
  • Asst. Lvg
  • SCN (aka nursing homes)
  • Medicare
  • Medicaid
All four of these are different topics and it seems people are getting confused about what answers are referring to what topic/business.

Firstly, U.S.'s Medicaid and Medicare are DIFFERENT PROGRAMS. Pls try not to confuse the two because at this point, people are posting questions/suggestions that may apply to ONE program but NOT the other. One is Federal, and one is State. As we have 50 states, we have 50 different versions of Medicaid, LOL - but only 1 version of Medicare.

Also, Assisted Living and Nursing Homes (Skilled Care Nursing facilities) are also two entirely separate businesses, and it's important not to confuse them because the regulations for these two can be quite different from state to state! Some facilities have both, but many specialize only in one business.

Medicare vs Medicaid
From HHS.gov: "What's the difference between Medicare and Medicaid? Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources."

Medicare is managed by the Social Security Administration:
  • Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
  • Part B (Medical Insurance): Helps cover: Services from doctors and other health care providers. Outpatient care.
Medicaid is managed individually by each state:
  • The government sets minimal standards only. It is funded 50% by the government and 50% by each state. States can (and have) declined to match federal funds; for example some states did not expand Medicaid enrollment during COVID-19 which paid for free vaccines as well as general healthcare for those eligible.
  • Medicaid pays for “medically necessary” health care.
Medicaid is a social welfare or social protection program, while Medicare is a social insurance program.
(sorry to cut this short, but I have to go make dinner, LOL. I'll post the AL/SCN definitions in a separate post later. HTH everybody, and thanks!)
 
George1959 said:
Here they even kick out seniors from nursing homes for refugees only for profit.
https://www.focus.de/panorama/plaet...echtlinge-mehr-geld-bringen_id_186945741.html
"In Berlin, 110 residents of a nursing home for the elderly were unexpectedly dismissed. The operator and landlord are church institutions belonging to the Berlin Diakonie. What is so piquant is that refugees are now being housed in the building, which is much more lucrative than care for the elderly because of public subsidies." (Quote from the article, translated by deepl.com)
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They can’t do that here in Canada. If you can’t afford to pay for a nursing home residency, the government has to pay for your stay no matter how long that is. The only reason they can legally kick you out is if you are physically violent with staff or others and even then it’s a lengthy process.
 
In my state much depends on whether or not a senior facility is for-profit or non-profit.

I've recently toured and talked to one of each. The for-profit told me that they warn their residents when they see their money is running low and encourage or help them apply for Medicaid. They do this because the homes that accept Medicaid have years long waiting lists. I didn't ask what happens if they aren't accepted at a Medicaid home in time. I just decided I won't be going to a for-profit.

The non-profit told me they help their seniors who are running out of money to apply for Medicaid and then they continue to live at the non-profit home. There is a law in my state that prevents non-profits from turning people out because they run out of money. I don't know if that law exists in other states or not. So, they get the big bucks until you run out and then they get the amount Medicaid pays until your family moves you or you die.
 
I know nothing about Medicaid, but apparently many millions got covered by it during the government Covid benefits program.

Now that protection, for Covid, is going away.
They no longer qualify, and they are getting kicked off the program because it is getting dismantled.
 
Myrtle said:
In my state much depends on whether or not a senior facility is for-profit or non-profit.

I've recently toured and talked to one of each. The for-profit told me that they warn their residents when they see their money is running low and encourage or help them apply for Medicaid. They do this because the homes that accept Medicaid have years long waiting lists. I didn't ask what happens if they aren't accepted at a Medicaid home in time. I just decided I won't be going to a for-profit.

The non-profit told me they help their seniors who are running out of money to apply for Medicaid and then they continue to live at the non-profit home. There is a law in my state that prevents non-profits from turning people out because they run out of money. I don't know if that law exists in other states or not. So, they get the big bucks until you run out and then they get the amount Medicaid pays until your family moves you or you die.
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Here is the problem:
Eldercare is now in the target sights of For-Profit Corporations. Non-profit care facilities are the perfect acquisition target for Big Corp. Every year, healthcare corporations have been buying up non-profit facilities and turning them into for-profit facilities. Think about it - why buy land, erect a building, furnish and staff it, dealing with expensive permits and constant inspections through a years-long process....when a company can simply arrange for a multi-million $$$$ loan facility (banks do it all the time; I worked in such a dept for almost a decade) and BUY a few non-profits to turn them into cash generators?

All agreements with the residents - who are often under even less legal protection than apartment renters, into which classification they actually fall - are null and void when the ownership changes. The new ownership can offer its own terms, "Take It or Leave It".

This is perfectly legal, and I am not saying that I'm against everything big corporations do. But unfettered capitalism can wreck havoc upon people's lives - and very often does.

I mention this because when we were doing research into senior facilities for my MIL, a subject I have written about several times here, one thing I have not mentioned was a followup anecdote. Some of you might recall that there were two excellent, highly-rated, full-care facilities that were the "finalists". Both "A" and "B" were non-profits, and both had wonderful campus arrangements - different from one another, but equally pleasant and sociable. We had visited both multiple times, and agreed they were exceptional.

I felt either one would be ideal for MIL. I told my Spouse he would be the decision-maker on this one, as it was his mom. He thought about it for a couple of days, and then selected "B". At that point we involved his mom, bringing her with us for another two visits to make certain she liked the facility.

The followup: less than a year after she moved into "B" (and was very happy there until she passed away), Facility "A" was purchased by a for-profit corp. The ratings plummeted and the staff, which had formerly shown a low turnover ratio, began to "churn".

We were fortunate that we escaped having to move her twice. It would not have been 'the end of the world', as she had more than enough funds for any facility. But we're glad she (and we!) didn't have to undergo a lot of unexpected stress over a declining situation.
 
officerripley said:
I didn't realize that Assisted Living homes took MedicAid at all; I don't think they ever have here in this state but maybe that's because it doesn't really use MedicAid but something called MediCal. And just about the only thing Medi-Cal pays for is Skilled Nursing Facilities.
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I don't think they do. Those nice looking assisted living buildings are a private pay and expensive.

And you are right about the nursing facilities.
 
Don M. said:
Medicare and Medicaid are becoming increasingly financially stressed with each passing year. Health care costs are soaring, and the number of elderly is increasing. The cost of moving to a good senior care facility can be thousands of dollars per month.
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Yep, you hit the nail on the head!! It's either spend more tax dollars or cut, or some of both. No other solution for the government.
Don M. said:
About the Only way to keep these costs manageable is to take out a good Long Term Care insurance policy....in the younger/working years when the premiums are still affordable.
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Maybe, my FIL did that and it did not seem like he was able to collect much from it when he needed it. So I didn't do it. Maybe I'll live to regret that decision, or maybe not...
 
Alligatorob said:
Maybe, my FIL did that and it did not seem like he was able to collect much from it when he needed it. So I didn't do it. Maybe I'll live to regret that decision, or maybe not...
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This was about 10 years ago, but the large newspaper in the capitol city in this state did a big expose' on those long term care policies and how in about 15 percent of the cases, it was a total rip-off. They followed one poor woman who had paid, I think it was about $600, a month for 1 of those policies for about 15 years, and when it came time to use it, the company kept throwing up one reason after another of why they wouldn't pay for the nursing facility she was in--her daughter had written proof from them that they would indeed pay for that facility--but they just kept not paying and then declared bankruptcy and slunk off into the night. So it ended up that the home that the woman had left to 1 of her kids and he and his family were living in had to be sold to pay for her facility and all her kids had to come up with $$ every month to pay for her facility until they could get the house sold and after that $$ was gone through and then they could get her on MediCal (MedicAid).

So like the article said, 15 percent doesn't sound like a lot but you look at just the above woman's case, it affected not only her but her kids and grandkids. So anybody who is considering taking out 1 of those policies should really look into it first.
 
We are fortunate with our long term care policies, as they were purchased under the management of the state pension fund, the largest in the US. They contract with a healthcare management company so that every policyholder who files a claim, immediately has a case rep assigned to them. The case rep is the contact for any complaints or issues with the LTCi policy payout.

Many older LTCi policies had the requirement that you were not in need of assistance unless you could not perform 3 or more of the 6 'normal daily activities.' Medicare, however, changed to a disability rating of non-performance of only 2 or more of the ADLs quite a while ago, and almost all LTCi policies now conform to Medicare regulations. Our policies do, even though they were purchased 24 yrs ago.

Also, almost all LTCi policies written within the last 20 yrs are tax-qualified. This is very important as the IRS sets taxable limits on the benefit amounts. Older policies were seldom tax-qualified, meaning that any benefits paid, would be taxed as income received during the calendar year.

There are new hybrid policies - Life/LTC and Annuity/LTC policies. These are financial products and quite complex; it's best to go over all the "fine print" with a legal/financial expert. I cannot speak to the tax-qualification of such policies, so best to ask an expert (which does NOT mean your insurance agent/broker, LOL).
 
Thank you for the clear, concise information, @Lethe200.

Both my mother and FIL were in nice assisted living facilities before their passing. Mom needed memory care due to vascular dementia. FIL was in a general area and suffered from early Alzheimer's. Both paid their monthly charges by check. No gov't assistance.

Nice ALs feel more like cruise ships than hospitals and are plenty spendy, but our parents had sufficient assets to cover the expenses.

DH & I did the research, visiting, interviewing and contract signing in both cases. Medicaid/Medical payments were never brought up by any facilities. Not even once.
 
Lethe200 said:
All agreements with the residents - who are often under even less legal protection than apartment renters, into which classification they actually fall - are null and void when the ownership changes. The new ownership can offer its own terms, "Take It or Leave It".

This is perfectly legal, and I am not saying that I'm against everything big corporations do. But unfettered capitalism can wreck havoc upon people's lives - and very often does.
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That's only legal because the previous agreements were not protective of the residents. If the residents held life estate agreements to stay in the facility until end of life, then any new owners would be required to respect those agreements. Thus the problem is twofold, that non-profit facilities do not provide agreements that protect the residents in the case of a sale, and even if they did, the new owners would probably make sure they didn't live very long.
 


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