March 9, 2023

Post-COVID, View of Nursing Homes Erodes

COVID has moved from a central place in our lives to a risk that, while still important to heed, has moved out of the foreground.

One thing we will not forget, however, is COVID’s toll on nursing homes and other long-term care facilities, where the virus has killed more than 200,000 older Americans and staff. The tragedy also played out in nursing homes in Canada, where the deaths received high-profile coverage in the news media, just as they did in this country.

A survey of Canadians at the end of 2020, while COVID was still raging, indicates that the pandemic caused major changes in their thinking about old age. The reaction of a majority of people in their 50s and 60s to what they saw happening was to say they intend to avoid ever spending time in a nursing home, according to a summary of the survey by Canadian researchers.

It’s not hard to understand why so many deaths left such a lasting impression. What may be more surprising is the potentially big shift in what Canadians now believe should be done to address the situation.

More than two out of three Canadians surveyed said government could increase taxes to fund more government support for someone to come into retirees’ homes and help them with daily activities such as cooking, shopping, showering, and dressing.

But home care is an expensive proposition: the cost of one month in a nursing facility in Canada would buy only about two hours of home care per day. However, about one in four individuals said they would also take more responsibility themselves for preventing a nursing home stay by saving money to pay for their future home care. …Learn More

June 2, 2020

Home Care Reform’s Outcome a Surprise

Medicaid pays for care for six out of 10 nursing home residents.

To reduce the program’s costs, the Affordable Care Act (ACA) encouraged states to expand the care that people over 65 can receive in their homes or through community organizations. The hope was that they would delay or – even better for them – avoid moving into a nursing home if they had easier access to medical and support services.

Many states historically did not use Medicaid funding to pay for home care. The ACA’s Balancing Incentive Payments Program required the 15 states that chose to participate in the reform, including Nevada, Texas, Florida, Illinois, and New York, to increase spending on home and community care to half of their total Medicaid budgets for long-term care. By the end of the program, the states had met their goals of more balanced spending on home care versus nursing home care.

But four years after the reform went into effect in 2011, the states’ nursing home population had not changed, compared with the states that did not expand their services, according to a University of Wisconsin study for the Retirement and Disability Research Consortium. The researchers said one possible reason the reform didn’t reduce nursing home residence was that people who were never candidates for this care were the ones taking advantage of the alternative forms of care.

The analysis did find other unintended consequences of the shift in Medicaid funds to home and community care. First, somewhat more older people moved out of a family member’s house and were able to live on their own.

Second, as more people moved into their own place, costs may have increased for a different federal program: Supplemental Security Income (SSI) for low-income people. The increase had to do with how this program calculates financial assistance. SSI’s monthly benefits are based on an individual’s income. When retirees decide to live on their own, the housing, meals and other supports the family once provided are no longer counted as income. The drop in a retiree’s income means a bigger SSI check.

On the other hand, the Medicaid reform may have financial benefits for caregiving families, the researchers said.

The greater availability of home and community care for seniors – whether they live with family or on their own – frees up time for their family members to earn more money at paying jobs. …
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