Nursing Homes Under Assault


An August 12, 2011, Healthcare Finance News article titled “Long-Term Care Group Urges Super Committee to Preserve Federal Funding” describes that the healthcare industry, including nursing homes and community caregivers, are preparing for the worst (MedTech Media 71 Pineland Drive, Suite 203 New Gloucester, ME 04260).

The Congressional Super Committee is charged with finding $1.5 trillion in budget cuts. Declarations from Congressional leaders indicating that everything will be on the table for the Super Committee have raised major concerns, and healthcare organizations representing community care givers and nursing homes and long-term care insurance providers are stepping up to urge lawmakers to preserve funding for these vital health services.

This is further indication that it is imprudent for anyone, except perhaps the most crippled and indigent, to expect the government to be capable of providing decent long-term care.

Gaming the System, Screwing the Country

It’s amazing but true: lawyers like Alice Reiter Feld in her newsletter, (Center for Asset Preservation and Long Term Care Planning, 5701 N. Pine Island Road, Suite 260, Tamarac, FL 33321) blatantly advertise how easy it is to shield, insulate and exempt assets from Medicaid spend down. Then the government (actually, we taxpayers) gets to pick up the tab for their long-term care (LTC) when people who follow Ms. Feld’s advice become eligible for Medicaid.

She writes, “At a recent meeting, the subject of nursing home care came up. One pastor in the group opined that, in order to get Medicaid to pay for such care, a person must have spent all his money. My husband (who’s been enlightened by his elder-law attorney/wife!) immediately corrected the pastor, advising him that this was not true. He then also advised him to get Nursing Home Medicaid advice from an elder law attorney.”

The truth is that Medicaid eligibility is riddled with loopholes, enabling many people to legally shield and divest their wealth, then get Medicaid to pay for their long-term care. I am all in favor of Medicaid-paid long-term care for those who are truly indigent. That is, after all, what Medicaid is supposed to be: a safety net for the poor. Nowadays, however, it’s taken advantage of by Medicaid planners like Ms. Feld, who make a nice living helping people with means gain access to Medicaid.

When people with home equity and other assets game the system as described, the federal government must find more revenue to meet the increased demand for Medicaid, which in turn increases our national debt or the tax burden on all of us.

Perhaps more importantly, Medicaid-paid long-term care is often very sub-standard. I strongly encourage Ms. Feld and her complicit husband, Rabbi Mitch, to visit a Medicaid-paid facility in a large city.  They can then provide accurate, detailed descriptions of the Medicaid-paid long-term care facilities their clients are planning to spend their final years in.  Perhaps Ms. Feld’s clients, including her husband, will consider alternative facilities before they divest and shield their assets.

Click here to see my recent article describing what Medicaid-paid nursing home care is like.

To Ms. Feld: I know you are making a good livelihood doing Medicaid planning, but I encourage you to expand your practice to other areas. You will sleep better. To me, you are a “bottom feeder,” doing what is legal, but is it ethical?  To your husband and others enthusiastic about this approach, I urge them not only to consider the ethics of saddling the US taxpayer, including themselves, with the bills for this slight of hand, but also to become better educated about the lack of options and poor quality that have unfortunately become synonymous with Medicaid-paid LTC.

Is Warehoused Long-Term Care Imminent?

For those who refuse to plan responsibly for long-term care, the nightmare of warehoused care that I think is a certainty in years to come, may be a very unpleasant reality sooner than I thought.

The July 29, 2011 edition of McKnights Long-Term Care News reports that Medicare payments to nursing homes would be trimmed by 11.1% beginning Oct. 1, under a corrective proposal the federal government issued.

The call for reduced funding comes amid reports that providers have been paid more than $2 billion above federal projections since a new payment system took effect late last year.

The recalibration will result in a reduction to skilled nursing facility payments of $4.47 billion or 12.6%, according to CMS. However, that drops to an 11.1% cut when offsetting increases are factored in.

Time to Think Outside the Box

My vigilant, passionate friend Steve Moses, president of the Center for Long-Term Care Reform, has just published an excellent blog about the changes that will be needed to safeguard Medicaid and Medicare.

Steve is a policymaker and I am a marketing person. I am going to give you the scoop using extremely broad brushstrokes. For more detail visit the Center for Long-Term Care Reform. If you believe in its mission, please contribute to it.

In a nutshell, our federal government has built up a hugh debt, which is growing every year because of annual budget deficits. State budgets are even worse off. The next big item on the budget cutting agenda is payments to Medicaid-accepting doctors, who already get paid far less than other doctors. This cannot be constructive. Medicare and Medicaid, in addition to education, corrections, transportation and infrastructure spending are also on track to be cut back, even though cutting these programs will be of great detriment to our society.

For years, some policy experts and organizations have known how to save Medicaid and Medicare for the people who genuinely need them.  The solution would be easy. All that would have to be done to avert a lot of our fiscal woes and set budgets back on the right track, would be to close some glaring loopholes. No longer should large home equities, businesses and other currently exempt assets be shielded from Medicaid spend down. It’s that simple. This has not been palatable in the past. We’re hoping that the timing is finally right and that politically, things are finally hitting rock bottom enough to cause legislators to “think outside the box” and adapt these simple solutions.

Entitlement Bandits Rob Medicaid/Medicare

A brief, new Cato Institue video explains the causes of high rates of Medicaid fraud.

The biggest reason is because Medicaid money is “other peoples’ money.” If Medicaid’s accounting were run more like private enterprise, like a credit card company, fraud would be cut down dramatically.

This video ties into long-term care (LTC) well because Medicaid pays for the majority of facility-based LTC in the US. As has been discussed in earlier LTCQueen blogs, if Americans want to “have their cake and eat it;” in other words, preserve wealth and have their loved one receive Medicaid-paid LTC, it is just not that difficult to “game the system.”