Opinion

Growing old has a staggering price tag

The letter from my husband’s nursing home informing me the cost of his care was going from $181.75 a day to $194.47 the first of the year was no surprise.

I clipped a Wall Street Journal news story in September saying the cost of nursing home care in the U.S. is rapidly outpacing inflation and the average daily rate for a private room was $192.

My diabetic husband shares a room with another man and the WSJ story didn’t spell out whether the $192 was for 24-hour nursing care, which is what he requires and not all such facilities supply.

It did say that people admitted to nursing homes today need more care and that older adults with mild infirmities often are settling in assisted living centers or opting for care at home.

The reason I’m telling you this is because you or someone in your family will very likely wind up in a nursing home before you slip the surly bonds of earth.

Check the deaths in the vital statistics column in your newspaper. Few die at home any more. People live much longer now, due to advances in medicine, and most require care a spouse cannot give.

Most people mistakenly believe that Medicare will pay the tab for nursing home care, but it will not. It only covers a transition period from hospital stay to the home. Then it’s up to you and whatever long-term insurance you may have.

The average length of a nursing home stay, according to government estimates, is 2.4 years.

That means, at $192 a day, the typical bill would total about $168,192.

If you or kin you support are already a nursing home patient, you’re going to get the same kind of letter I got, telling you rates are going up. Unless, of course, you are on Medicaid, in which case the bill or request for reimbursement of same will be presented to the 2005 Legislature.

We are now at the crux of the problem.

Seventy percent of the residents in nursing homes are on Medicaid, says Jonathan Eames, executive director of the Washington Health Care Association, and funding by the state for Medicaid patients has been steadily decreasing. “Health care is the only place where the state pays dimes on the dollars for services received,” he said. “When you build a bridge or a road, you contract with the builder. There’s a bidding process, how much to do it. The state pays it. With health care, the state determines what the best rate to pay a facility and short changes the residents.”

So what happens when the cost of care for Medicaid patients is higher than what the state provides? Why, they do what hospitals did some years ago when faced with the same situation.

They pick up what’s needed by raising the rates on the paying private customers, like me. Some nursing homes won’t take Medicaid patients because they make more with the private payers.

My husband’s long-term care insurance reimburses me $100 a day, but I have to pay the remainder. In 2005, at $194.47, I will pay the home $70,981 of which I will be reimbursed $36,500 by long term care.

Doctor bills still will be paid by Medicare and KPS, but the drugs are on me. Cost is outrageous.

The drug bill for last month was $1,315, after a 30 percent discount.

No, I am not tempted to do what’s called “spending down” to be broke enough to get on Medicaid, but I am not critical of those who do that even when what they don’t pay is part of my bill. I know such people whose Alzheimer’s-stricken spouses have been in nursing homes for years.

So what is Eames going to do about the obvious inequity between payers and non-payers?

“The association is going to the Legislature and saying we need to fund these nursing facilities, the homes, assisted care and assisted living, who are being short changed on Medicaid, too,” he said. “All we are asking for is the cost it takes to take care of these residents. Currently, we are being paid in 1999 costs to maintain high quality care. We simply want what it costs to take care of them. The state has to come to a conclusion that this should be a top priority. They should understand that the frail and the vulnerable have a tougher time taking care of themselves.”

Adele Ferguson can be reached at P.O. Box 69, Hansville, WA. 98340.

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