Friday, September 16, 2011

Would You Like to Be Forced Into a Nursing Home?

How would you feel if you are 80 years old and forced into a nursing home because you needed some care and there were no family near to help you and you couldn't afford to pay for homecare? What if the nursing home you were being sent to from the hospital had a bad reputation but you could no longer stay at the hospital and it was the only one that had a Medicaid bed open? What if you refused but were told you were not safe to go home alone and sent anyway?

This is the state of the current system when a senior needs care and can't afford to pay for it. They are basically forced into nursing homes on Medicaid. Imagine being forced from the home you love, all your belongings, and comforts to begin living in a 10x10 space that allows 1 chair, and a few small possessions? What if you had a room mate that screamed throughout the night, rumbled through your belongings and you had no real privacy? The fact is this happens to countless seniors on a daily basis.

It's not the fault of the hospital, physician, adult protective services, or even the nursing home, as many many think. The truth is hospitals, physicians, nurses, and discharge planners are almost always looking out for the well being of the patient. They have concluded that the patient needs care and is unsafe alone, but the state of our current system doesn't allow a choice.

In this economic climate we all see how quickly anyone can go from wealthy to middle class, or even broke. How middle class is edging more towards poverty every day, and no matter how hard you worked your whole life, or what you were promised for retirement, you can find yourself in a very different and difficult financial situation. Prior to retirement or a devastating illness or injury there is opportunity to work at regaining wealth or going back to a higher income level, but what about those who are too old or too disabled to work? People have lost their entire nest eggs in the stock market, scams, or through devastating illnesses, injuries or acts of God.

Should hard working citizens who have contributed their whole lives be forced into nursing homes because their personal income doesn't allow choice? I say NO! Our current system does not allow choice. Yes there are some programs that allow minimal homecare benefits through Medicaid, but the truth is it is very minimal, it is often closed to new applicants and is often provides services from agencies who are less than satisfactory. That is not to say that every program in every state only contracts with poor service providers, but in the State of Michigan, where I live and provide services, the Medicaid Waiver program which it's called here, reimburses so little we would be in the red for every single hour we would contract.

For agencies that spend the money to hire great caregivers, provide a thorough training program, pay a decent wage on hire and raise wages with loyal and committed caregivers to retain them, they cannot afford to participate in these Medicaid programs. The retention rate in my Visiting Angels agency is excellent. I have several caregivers who have been on our care team for between 3 and 8 years. Our long term caregivers make more in their hourly wage than the Medicaid Waiver program even pays. Then you add the Medicare and Social Security taxes we have to match, the costly Workmen's Compensation and liability insurance that we pay for each caregiver and we would be in the hole $4-$5 an hour for every hour we provided care as a vendor for the waiver program.

I have been to advocacy meetings with State Representatives and the Administration over the waiver program expressing my opinion and concerns about their low reimbursement rates and they have no answers. They seemed to understand the points about poorly trained care providers, excessive turnover and the lack of choice in providers for waiver recipients. My agency has received several calls over the last 9 years from Medicaid Waiver clients who tell us about the horrible care they're receiving, asking us to be the provider. Its heartbreaking to tell them "we're sorry, we don't participate in the program." This doesn't even take into account the amount of calls we receive from individuals or family members who need care for themselves or a loved one and can't afford it, or are saddened and lost to find out health insurance and Medicare don't pay for private duty homecare services.

Our system is a mess! There is a heavy threat looming over the state of Medicare, Medicaid, and Social Security, and equal concerns about rising healthcare and drug costs, yet the government is yet to recognize the savings from allowing private duty services as a choice.

Most seniors who are in need of care or services could get by with a few hours a day. They don't require the 24 hour care which is provided in the nursing homes they're paying for now. Facility care also comes with some very expensive risks that remaining home doesn't. Things like community acquired infections, bedsores, decreased mobility, falls, dehydration, poor med compliance, poor nutritional status, and depression all cost millions of dollars. According to a 2010 article in Medline The cost to heal a single full-thickness pressure sore may be as high as 70,000 dollars.[1] The overall annual cost has recently been estimated to be between 5 billion and 8.5 billion dollars.

The Agency for Healthcare Research and Quality released a study in 2009 of falls in the elderly from 2006 statistical information. As you can see by the chart below the costs are outstanding.

According to the Family Caregiver Alliance expenditures for skilled nursing facility (SNF) care are much greater than care provided in other settings. Average expenses per older adult in a skilled nursing facility can be four times greater than average expenditures for that individual receiving paid care in the community.

I don't think I need to go on about the statistical costs.(click on the Family Caregiver Alliance for more statistical evidence). The evidence is there, yet the ability to choose private duty services is not a viable option.

I have started a petition that demand choice. Unless we advocate and push for the ability to choose it will not happen in the near future, if it happens at all. If you would like to have a voice for your loved ones and/or yourself I urge you to sign the petition and pass it on. I am Currently looking for a minimum of 10,000 signatures. Together we can make a difference! Thank you!

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Angil Tarach-Ritchey can be reached for questions or comments at or other contact options at


  1. I don't want to be force to anything, but if it's for my best interest to go to a Nursing Home,i'll definitely do it.

  2. Thank you for your comment. The problem is that financial status should not be the deciding factor. Best healthcare interest and financial interest are 2 totally separate issues. I would venture to guess that the majority of seniors forced into nursing homes on Medicaid are not receiving the care that is in their best interest.
    Best interest is not just physical health, it is also mental health. If a person in need of care does not want to go to a nursing home and wants to remain at home it is not in their best interest to be forced from their home into a nursing home, assuming they're capable of making decisions.
    The other problem is when a person is forced into a nursing home on Medicaid, from say a hospital discharge, they don't have the ability to choose which facility they go to. The Discharge Coordinator will find the first Medicaid bed available and that is where they go, unless they have an advocate that has alreeady checked out local nursing homes and refuses to allow their loved one to go to a particular facility and is very assertive about it.
    The article is focused on lack of choice due to financial status and nothing more.


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