Angry about Medicaid? It’s Time to Face Reality

Pamela D. Wilson, CSA, MS, BS/BA, CG

In recent months I’ve met with an increasing number of families trying to figure out how to access long term care for their parents. The challenge for most is that they never for a moment considered that they would have to pay for care; they simply assumed the government would take care of it. This illustrates very clearly the looming long term care problem in the United States. We don’t have a system that educates or requires individuals to pay for their health insurance (or very much of the premium) during years of employment which results in the assumption that long term care is also paid for by “someone”. Many individuals who do not plan ahead have no choice but to access the government Medicaid program.

More importantly, families are angry about the financial requirements. Some seek to figure out creative ways to avoid giving up assets in order to spend down to the financial level required to access Medicaid. After all, the children want their inheritance and due to recent economic issues, many children see accessing their parent’s retirement savings or home equity as way to bail themselves out of financial difficulties.

To many, this sounds cold; children seeking to use their parent’s assets for their own financial good. It happens more often than one would think and is one of the most under-reported crimes against the elderly. In fact a summit held in Denver reported that financial abuse of the elderly is most commonly committed by family members.

How does this financial abuse occur? Why should families be more realistic about Medicaid? The government has taught us an important lesson, why pay for care when the government gives it away? So why would families not seek ways to keep money, investments and assets away from the government? The difficulty is the ethical decision between retaining assets and accessing quality care for family members. Government programs show it is nearly impossible to accomplish one without giving up the other.

This is clearly illustrated by public perception of the quality of care in nursing homes. How many people do you personally know who look forward to spending the rest of their life in a nursing home? Yet how many people realize that nursing home care represents the most significant portion of Medicaid spending? By not planning to fund long term care expenses most individuals are pushed into the nursing home system.

Sure, it’s easy to complain about the poor quality of care in nursing homes. How many people realize that Medicaid reimbursed $13.15 per bed per day below break even costs for nursing homes in 2006? How can individuals receive quality care in nursing facilities that lose money on large numbers of patients? It’s time for us to realize that we get what we pay for and if we want to access quality care we, not the government, are going to have to pay for the care.

There are many older adults and parents scarcely managing in private homes while families are trying to hold onto assets so as not to spend them for care. Where is the logic? Where is the ethical responsibility and balance between accepting personal responsibility for our own care by spending our own resources for quality care versus the expectation that our money is our own and the government should pay for care? How many care more about retaining family money and inheritances versus providing needed care that is in the best interests of family members?

These are tough questions to ask and even more difficult to answer especially when the immediacy of reality and the need for care is upon us. Often I find myself the bearer of bad news when I give families the list of requirements for Medicaid. I become the adversary versus the advocate when families want to retain assets and they feel I now have too much information or am in a position to judge their decisions.

It is difficult enough to find oneself in a position of having to make difficult decisions about the care of a family member, let alone to then live with the consequences and the guilt of choice made. Research shows an abundance of situations where family caregivers experience a great deal of guilt regardless of the outcome of their decisions. My position as an advocate is not as a judge; my position is to give families and individuals information to allow them to make their own decisions and then look to their own future. If as caregivers we don’t want to end up in the same situations we’re experiencing with family members, we must plan and pay for our own long term care.

Investigating and learning about long term care insurance is one way to plan for a future of quality care not reliant on strained government programs resulting in financial losses for those providing care. Even the best of us cannot continue to maintain long term when our monthly expenses are greater than our income. How can we expect those providing services reimbursed by government programs to do the same and then complain about their ability to provide quality care?

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