Assisted Living Facilities are evicting Medicaid residents after they drain their life's savings

[Jwheel86]

Seniors on Medicaid are getting evicted from assisted-living homes - The Washington Post

WWW.WASHINGTONPOST.COM

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Residents who drained their nest eggs to cover private-pay rates have been evicted after turning to Medicaid to pay their bills.

 

Quote

The evictions carry an especially harsh sting for residents who enter assisted-living facilities paying full rates out of pocket with the understanding that, once their nest egg has been spent down, they can remain in the facility under Medicaid. Such arrangements are common across the country and are discussed with families by marketing staff, according to elder-law attorneys and industry experts.

 

But facilities may have strict limits on the number of beds they designate as Medicaid-eligible, or they can back out of state Medicaid contracts completely. Such caveats may be buried in the fine print of resident agreements or are not addressed at all in the contracts, according to contract provisions in the Wisconsin cases reviewed by The Post. Families often sign such contracts in a time of stress, as they are seeking a safe place for a parent who can no longer remain in their own home.

 

Abolish nursing homes. Abolish Medicaid Managed Care Organizations. Abolish Medicaid waivers. 

[unogueen]

Without these new problems, assisted living was always hell. My first clinical trials was at one and for good reason. You learn everything you don't do. I only imagine this is tolerated because we imagine faculty loss with age.

[BloodyHell]

On 4/7/2023 at 10:12 PM, Jwheel86 said:

Seniors on Medicaid are getting evicted from assisted-living homes - The Washington Post

WWW.WASHINGTONPOST.COM

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Residents who drained their nest eggs to cover private-pay rates have been evicted after turning to Medicaid to pay their bills.

 

 

Abolish nursing homes. Abolish Medicaid Managed Care Organizations. Abolish Medicaid waivers. 

And what, leave millions of elderly on the street?

 

It’s a bad system, but that doesn’t change the fact it’s the only system.

 

Obviously ways are needed to prevent this horrible profiteering, but the idea things would bd better without nursing homes seems wrong. 

[SuperSpreader]

1 hour ago, BloodyHell said:

 

It’s a bad system, but that doesn’t change the fact it’s the only system.

 

[Fizzzzle]

I am really in a fuck everything in particular mood today and this isn't helping.

[SuperSpreader]

1 minute ago, Fizzzzle said:

I am really in a fuck everything in particular mood today and this isn't helping.

 

[Jwheel86]

45 minutes ago, BloodyHell said:

And what, leave millions of elderly on the street?

 

It’s a bad system, but that doesn’t change the fact it’s the only system.

 

Obviously ways are needed to prevent this horrible profiteering, but the idea things would bd better without nursing homes seems wrong. 

 

It isn't the only system. With a few exceptions, home and community based settings provide better quality care at a lower cost. There is this misconception that a single caregiver caring for multiple residents is cheaper than 1-1, but when you factor in the wild over head cost of facility based care, the economy of scale get lost. $5k/mo x 12mo = $60k a year. That's enough to hire multiple caregivers at a decent wage for home care. The issue with Medicaid is that HCBS is funded through a waiver system which requires the States to fund each individual waiver slot, the result being massive waiting lists for Medicaid HCBS funding (5-20 years), that system doesn't apply for facility based care (the Medicaid Institutional Bias). Even when you move up the care intensity need, HCBS is still generally cheaper (even when not, it actually is cheaper since the per resident cost for Medicaid spikes with fewer residents at that care facility/level).

 

The problem is Medicaid can't get out of its own way to enable a fully comprehensive HCBS system. Here's an example in my state. If you've got the Intellectual Developmental Disability Medicaid waiver, it'll fund home care or Group Homes (which have very strict rules on size and community involvement), but if any part of your care requires Skilled Nursing, you have to go into an Intermediate Care Facility (a non waiver service) which has costs that are insanity. This despite the fact that Private Duty Nursing is a Medicaid non waiver service, but because stupidity (and great ICF lobbying), waiver and non waiver services can't overlap. 

[Zaku3]

To back up your sentiment we don't really have multigenerational homes. Ny grandma had Alzhimer's and we couldn't take care of her I had to work and mom is a workaholic. We sent her to my aunt's house in Colombia and that worked out better I feel. It sucked I couldn't see her but I felt more comfortable about her being with family as opposed to in a nursing home or adult day care or whatever. 

 

I listened on chapo a few weeks ago about an article that Medicaid can take your home from you when you die as a way of reimbursement for coverage. We are a cruel society.

[b_m_b_m_b_m]

38 minutes ago, Zaku3 said:

I listened on chapo a few weeks ago about an article that Medicaid can take your home from you when you die as a way of reimbursement for coverage. We are a cruel society.

Ah yes, but only if you don’t have the 5 year look ahead foresight to put your home in a Medicaid trust so that they can’t come after your home.

 

but yeah generally Medicaid LTC will wipe out the savings and home equity of everyone that isn’t wealthy and requires care. 
 

I mean also private facilities may require that you have a certain amount of assets that you basically have to sign over to them in order to get care there. So unless your family can provide care or you’re wealthy you are gonna get screwed!

[CitizenVectron]

Multigen households might solve much of this problem, except that fewer people are able to stay home and care for others compared to the past due to inflation (and stagnating incomes) over the last 50 years. 

[BloodyHell]

1 hour ago, Jwheel86 said:

 

It isn't the only system. With a few exceptions, home and community based settings provide better quality care at a lower cost. There is this misconception that a single caregiver caring for multiple residents is cheaper than 1-1, but when you factor in the wild over head cost of facility based care, the economy of scale get lost. $5k/mo x 12mo = $60k a year. That's enough to hire multiple caregivers at a decent wage for home care. The issue with Medicaid is that HCBS is funded through a waiver system which requires the States to fund each individual waiver slot, the result being massive waiting lists for Medicaid HCBS funding (5-20 years), that system doesn't apply for facility based care (the Medicaid Institutional Bias). Even when you move up the care intensity need, HCBS is still generally cheaper (even when not, it actually is cheaper since the per resident cost for Medicaid spikes with fewer residents at that care facility/level).

 

The problem is Medicaid can't get out of its own way to enable a fully comprehensive HCBS system. Here's an example in my state. If you've got the Intellectual Developmental Disability Medicaid waiver, it'll fund home care or Group Homes (which have very strict rules on size and community involvement), but if any part of your care requires Skilled Nursing, you have to go into an Intermediate Care Facility (a non waiver service) which has costs that are insanity. This despite the fact that Private Duty Nursing is a Medicaid non waiver service, but because stupidity (and great ICF lobbying), waiver and non waiver services can't overlap. 

Thanks for that.

 

still though, isn’t it true that there just isn’t nearly enough home care providers for all the people that require it? Seems to be the case with families of people I know that the problem isn’t getting home care covered, but finding people to do the job? I’ve never had to deal with it, so im not sure what the pay is, but im sure it’s a problem for retention.

 

Edit: I’ve also known two people who quit home based care because of nightmare clients. Real angry, hateful people. I’m sure ghis isnt the norm though. 

[Jwheel86]

33 minutes ago, b_m_b_m_b_m said:

Ah yes, but only if you don’t have the 5 year look ahead foresight to put your home in a Medicaid trust so that they can’t come after your home.

 

 

My parents just rewrote their will to put everything I'd get into a 3rd party Special Needs Trust so the assets won't make me ineligible for Medicaid and that my family can themselves inherit whatever is left. Only downside is I have to have a Trustee. 

[Jwheel86]

1 minute ago, BloodyHell said:

still though, isn’t it true that there just isn’t nearly enough home care providers for all the people that require it? Seems to be the case with families of people I know that the problem isn’t getting home care covered, but finding people to do the job? I’ve never had to deal with it, so im not sure what the pay is, but im sure it’s a problem for retention.

 

The workforce issue is huge, but facility based care is having the exact same issue to the point where it becoming unsafe as caregiver to resident ratios explode. 12-20 residents per caregiver isn't unheard of and is extremely dangerous. 

[Captain Pickle]

2 hours ago, Fizzzzle said:

I am really in a fuck everything in particular mood today and this isn't helping.

Me too! Wind was against me on my way to work and n my way back. Just one of those days

[BloodyHell]

12 minutes ago, Jwheel86 said:

 

The workforce issue is huge, but facility based care is having the exact same issue to the point where it becoming unsafe as caregiver to resident ratios explode. 12-20 residents per caregiver isn't unheard of and is extremely dangerous. 

Thanks. Its such a complicated issue. I 100% understand why you feel the way you do, I don’t know your situation, but I’ve seen you mention that you are in a chair and require care. It must be incredibly frustrating, and I hope whatever happens you find a way to stay in your home.

 

There’s definitely no good answers. 12-20 per worker is awful. For people with nobody, that seems even more dangerous than care homes. Is 20 with one worker in one home worst than 20 with no workers alone in their own homes?

 

it’s definitely something that needs to be solved, and not just in America. Not just the money to care for the elderly and vulnerable, but also the manpower. people definitely deserve better.

[CastlevaniaNut18]

53 minutes ago, b_m_b_m_b_m said:

Ah yes, but only if you don’t have the 5 year look ahead foresight to put your home in a Medicaid trust so that they can’t come after your home.

 

but yeah generally Medicaid LTC will wipe out the savings and home equity of everyone that isn’t wealthy and requires care. 
 

I mean also private facilities may require that you have a certain amount of assets that you basically have to sign over to them in order to get care there. So unless your family can provide care or you’re wealthy you are gonna get screwed!

I could have sworn it was 7 years. We recently went through that with my husband’s grandma. She went to a NH last year when the money for sitters was out. His mom and uncle had taken steps prior to keep the house in the family. 
 

I think my mom and aunt have done the same with my grandma. She’s 87 and it’s about to come to putting her in a NH because she’s not doing so well on her own. But it’s gonna be a nightmare because she’s already a difficult personality at her baseline and isn’t so far gone she doesn’t realize what’s happening. 

[Anathema-]

Cheap multi-occupancy living for both seniors and young people out on their own for the first time pls

[Anathema-]

Just now, Anathema- said:

Cheap multi-occupancy living for both seniors and young people out on their own for the first time pls

Like a county dorm for old and young people. 

[b_m_b_m_b_m]

23 minutes ago, CastlevaniaNut18 said:

I could have sworn it was 7 years. We recently went through that with my husband’s grandma. She went to a NH last year when the money for sitters was out. His mom and uncle had taken steps prior to keep the house in the family. 
 

I think my mom and aunt have done the same with my grandma. She’s 87 and it’s about to come to putting her in a NH because she’s not doing so well on her own. But it’s gonna be a nightmare because she’s already a difficult personality at her baseline and isn’t so far gone she doesn’t realize what’s happening. 

Generally varies by state (iirc CA is 30 months) but 5 years seems to be the norm. Consult an estate planning lawyer and tax professional

[CastlevaniaNut18]

1 minute ago, b_m_b_m_b_m said:

Generally varies by state (iirc CA is 30 months) but 5 years seems to be the norm. Consult an estate planning lawyer and tax professional

I guess it's 7 here, because I repeatedly heard that number with my in-laws.

 

Currently not something I'm worried about, given my parents aren't quite to their 60s. I don't know what I'll do when the time comes. I couldn't live with mine and I have no desire to move back home.

[b_m_b_m_b_m]

4 minutes ago, CastlevaniaNut18 said:

I guess it's 7 here, because I repeatedly heard that number with my in-laws.

 

Currently not something I'm worried about, given my parents aren't quite to their 60s. I don't know what I'll do when the time comes. I couldn't live with mine and I have no desire to move back home.

At this age is when they and you should be planning for these future needs. Their assets should be protected now if they can manage the costs associated with that especially given the long look back period. Even more so if there’s a history of Alzheimer’s or dementia in the family. 

[CastlevaniaNut18]

4 minutes ago, b_m_b_m_b_m said:

At this age is when they and you should be planning for these future needs. Their assets should be protected now if they can manage the costs associated with that especially given the long look back period. Even more so if there’s a history of Alzheimer’s or dementia in the family. 

I kinda figure it's something my brother will be dealing with more, since he still lives close and deals with them on a daily basis. I  don't even know how to broach the topic at this point. Especially with all the stuff going on with my mom dealing with cancer.

[TUFKAK]

There’s no real solutions as the nursing crisis will only worsen and there’s already a massive need for home health nurses. As we continue to leave the career the problems will only snow ball.