Who are the needy? Or the poor. However you want to phrase it.
That's been a big part of the debate regarding the viability and profitability of the Champaign County Nursing Home. The debate has been generally focused on Medicaid vs. private pay patients. Those on medicaid are thought to be poor and more in line with what should be the Nursing Home's mission as a public institution to help those in most need. Those private pay people can go anywhere and the public nursing home ought not be overloaded with such people.
The reality is much different. Clearly, a Medicaid resident should be classified as poor. A few accounting tricks over a lifetime might give you a life of relative affluence while having minimal assets, but this is certainly not the norm.
Private pay individuals are those people that have assets that allow them to afford care. But many of these people are truly poor, and will only be able to afford care for a limited amount of time. Here's an example.
Let's say you have income from Social Security of $1200 per month, you've saved $50,000 in IRAs and other retirement funds, and you've sold your home for a net gain of $100,000. Under this scenario, of $150,000 in assets and $1200 in fixed income, I believe that you're a private pay individual. I'll leave others with more knowledge to fill us in on just how far you have to "spend down" your assets, but I'm pretty sure it's well below $150,000.
So your income amounts to about $2,000 per month when you include return on your investment. Not too bad if you're in assisted living at $2500 per month. That will last you about 15 years. But if you're going into a nursing home at $4,000 a month, you'll be tapped out in four years.
Clearly that person who is private pay is far from being rich. Not destitute, but clearly a person that fits into the mission of the public Nursing Home to help the "needy".
My experience has been that within the admissions process, assets and income are both given by the prospective resident. I think this part of the population, those with assets, but undoubtedly on their way to Medicaid, should be included in the discussion on what our mix should be between private pay and Medicaid patients.
Huge unknown variable--when an individual enters a nursing home situation, one has no idea how long the individual will be there. Claimed average is 3-4 years. This is countered by those who are there 10-20 years. In other words, an individual might come in as private pay, but spend out then fails into other categories. So what data tables are needed to create this mix discussion that you are putting on the table? Or is a resident asked to move when the funds move the individual from private pay to medicare? How important is it that there be a financial balance or is it more important to establish a philosophy of health care and populations to be served for the nursing home?
Pattsi Petrie
Since the county doesn't have the cash for additional rounds of bailouts, the home has to get its revenues and expenses into balance, period. It ought to be a simple accounting problem to determine the maximum ratio of Medicaid to private-pay patients the home can afford to take, minus a safety margin to avoid having to kick patients out or miss payrolls due to short-term fluctuations (like Pattsi's scenario). If this resulting ratio is philosophically objectionable, changing it requires reducing costs, raising private-pay rates, and/or raising taxes. Philosophical objections won't raise Medicaid reimbursement rates to cover the cost of care.
rondipass:
Your point is very good Mark. This is even worse than you think. It's called "pauperization". it is usual, not exceptional. Unless you have a nursing home insurance policy, to prolong things by paying part you will become a pauper fast and then you are a medicaid "consumer" (that's modern lingo in circles of government, insurance, HMO; goes with "provider").
There is no way to make the situation nice. Even with a "richer" mix of private pay, you are in trouble---I do not care what the outside expert claims she can do.
To get the real scoop is easy, just ask the a nursing home administrator to give you those numbers, or call the state.
Only the very wealthy or sick and frail who die soon, do not run out of thier money. Most advisors tell you count on it in your estate plans.
Your example rate is way low; used to be the rate is far more than $4000 a month---where is it now, maybe around $72,000 a year?
There's no mystery---your "private" money goes to the nursing home to pay for care, until you run out, period. You do not get kicked out, you go on medicaid rolls. Same place, same care.
If you have a house, I think it gets taken too to get medicaid eligible. But. if you are married, your spouse gets to keep the house, and some fixed amount of assets, I think it was $60 grand.
This is about a major disaster. The medicaid rate is rotten. It was before the recent cut. It is so outrageous, our political class should be called to account. When the state cut the rate, the governors office dictated it, and negotiated it in the plans it sent to the feds who signed off. It is beyond me that it is not a public scandel, but our state is used to this kind of garbage. Put it together folks, this is Illinois, which runs around 1.5 billion in unpaid medicaid bills rolled over every year.
The same disaster applies to the medical outpatient and hospital arena---government reimbursement is terrible, and it is a massive hidden tax----those with money pay for those who don't have much, because the state and feds do not want to pay their bills. Period.
If you go near any nursing home for care, you will find the care is risky, at best fair, more like poor. Champaign County has, or had, the reputation as the best locally, although Gibson City was maybe better. But, believe me, that is not desireable, unless you are so frail you and family are ok with just the minimum---and I don't blame the staff and management.
Ask the manager to tell you what is the dollar amount cost of care per patient/day and what is the percent of actual cost, including capital costs, covered by medicaid, and what is the cost of "desireable" care, and the percent of that covered by medicaid.