Mom’s Journey to the Nursing Home, Part II

The last article I wrote began mom’s journey to the nursing home. Mom had fallen at home and broken her hip. After a brief stay in the hospital in order to have surgery for her broken hip, mom entered a rehabilitation center—also known as a nursing home—to receive rehabilitation for her newly mended broken hip.

The nursing home had just informed mom that her days of covered rehabilitation—covered by the Medicare program—were ending. The nursing home now wants to discharge mom. The family is genuinely concerned. Before her fall, mom was living alone and managing (with great difficulty) her own affairs. The family thought mom would need long-term care in a facility soon, but they were not prepared for her needing long-term care this quickly.

Mom has four children. Two of her children live around her, but both of them work five days a week. None of her children can afford to care for mom—either financially or timewise—and none of her children really want to dedicate themselves to caring for mom; the care she needs is beyond any of their skill levels.

The family is scared. The nursing home is telling them that they are going to discharge mom home. The nursing home says the facility has no open beds and no “Medicaid beds.”  Medicaid is a needs-based health payment plan for needy individuals. If an individual qualifies for Medicaid, the program will pay for most of the costs associated with the nursing home.

As I mentioned in my prior article, nursing homes have a love-hate relationship with Medicaid. Nursing homes like Medicaid because the facility is guaranteed payment for those residents who qualify for Medicaid. Nursing homes hate Medicaid because the program only pays about $5,500 a month for each Medicaid beneficiary/resident.

Many nursing homes charge between $10,000 and $15,000 a month to residents who are paying for the facility privately. Receiving $10,000 less a month is a big financial hit for nursing homes, so nursing homes are not in love with residents who qualify for Medicaid.

With that said, a nursing home cannot treat a Medicaid resident differently than a resident who is private paying, and in my experience, nursing homes do not treat Medicaid beneficiaries differently. If a nursing home participates in the Medicaid program—and almost every nursing home in the state of New Jersey does participate in the Medicaid program—then the nursing home agrees that 45% or more of the facility’s residents can be Medicaid beneficiaries. In my experience, anywhere from 50% to 100% of nursing home residents in a given nursing home are Medicaid beneficiaries.

The staff who work at nursing homes are professionals. The staff has vast experience in running nursing homes and working with the Medicare and Medicaid programs. The staff understands (basically) how mom is going to progress and what the facility is (basically) going to tell the family from the moment mom enters the facility. The staff has seen people such as mom hundreds of times a year.

For the family, this is likely their first experience with a loved one needing care. To them, it is scary, personal, and confusing. The family believes that the staff of the nursing home are professional health care providers and everything the staff tells them is to be taken as gospel.

Now this is not to say that the nursing home staff are not caring, professional individuals. Most are. But almost every nursing home in the state of New Jersey is a business, and as is true of most every business, nursing homes want to make money. They are not—and they should not—perform their services for free or without payment; on the other hand, most every nursing home has agreed to accept Medicaid benefits as payment in full.

Most every bed in most every nursing home in this state is dual certified as a “Medicare bed” and a “Medicaid bed.”  The bed in which mom was receiving rehab is both an available bed and a Medicaid bed. The facility cannot discharge mom home unless the facility comes up with a reasonable discharge plan, and by law, sending mom home alone or saying that a family member must care for mom is not a safe discharge.

In short, the nursing home is responsible for mom’s care and must continue to provide that care. The family, not the facility, is in the position of power. Yet all too often I see scared family members who believe they must obey everything the staff of the facility is saying. Untrue.