Government funding system contributes to nursing home abuse. June 16, 2009

Nursing home care is expensive. Many people do not have long-term care insurance and cannot afford to pay It’s a private nursing home fees. The result is that government pays for a great deal of nursing home care through Medicare and Medicaid.

The problem is that because these programs taken together do not pay well they make it difficult for nursing homes to both make a profit and to provide quality care. Thus, many nursing homes choose to limit staffing in order to make a profit. Inadequate staffing in turn results in abuse and neglect of nursing home residents.

Medicare taken alone reimburses nursing homes at a profitable rate. However, Medicaid can pay at a rate that causes a loss for the nursing home.  Nursing homes try to offset losses from Medicaid patients with profits from Medicare patients.

Medicare, however, pays for only a limited time and only for those who meet specific guidelines.   Medicare does not pay for “custodial care,” including help with your activities of daily living such as getting dressed, feeding yourself and bathing. If you do not need  “skilled nursing care” Medicare will not pay. “Skilled nursing” includes care such as intravenous injections and physical therapy and requires staff such as registered nurses and physical therapists.

Medicare pays “full cost” for only 20 days. After that the patient pays a large copayment up to 100 days and then Medicare pays nothing. Once the 20 days is up, nursing homes know their profit margins will go down.

Tragically we have seen many cases in our Daytona Beach-based nursing home neglect practice where the nursing home discharges a patient home on the 20th day even if the patient is terribly sick. Sometimes the patient dies because of the discharge.

Therefore, one of the most important conversations you will have with nursing home staff will be with the discharge planner. We recommend that you make it clear to the planner that the choice of healthcare providers after 20 days should be based on the patient’s condition rather than Medicare’s ending reimbursement.