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Medicaid and Nursing Homes: Why Is It So Hard to Age in Place?


Nursing homes have been the subject of constant criticism during the pandemic. Poor safety regulations, inadequate staffing, lack of PPE, and confusing admitting procedures have turned these long-term care facilities into hotspots for the coronavirus.

By August 20th, 70,000 nursing home residents and staff had died from the pandemic, according to a study from the Kaiser Family Foundation. Instead of risking their health in a long-term care facility, many seniors, low-income adults, and those with disabilities now prefer to stay at home. Recent statistics show that almost 80% of adults age 50 and older want to remain in their communities and/or homes as they age, but this just isn’t an option for many Americans.

Find out why it’s so hard to age in place in today’s healthcare industry.

Who’s Living in Nursing Homes?

Across the U.S., around 1.4 million people live in nursing homes.

However, recent reporting from Forbes shows that hundreds of thousands of nursing home residents don’t need to be there. Very few require around-the-clock care that nursing homes provide. In 2017, AARP found that about 11% of nursing home residents had a low level of personal care needs. In 2018, the Kaiser Family Foundation found that just 1.6% required intravenous therapy, 4.5% required tube feeding, and 5.7% had a catheter. Just 20% needed injections. However, many residents struggle with incontinence, bathing, eating, and other daily activities.

Many of the services that nursing homes provide can be performed by a home health aide, therapist, or licensed practical nurse. So, why are so many people living in nursing homes if they don’t need to be there?

Why Patients See Nursing Homes as Their Only Option

Medicaid provides financial assistance to low-income adults and those that require long-term care, including those with disabilities. However, Medicaid is required to provide care in “nursing facilities.” About 80 percent of long-stay residents are on Medicaid.

Patients and individuals can apply for special waivers in their state, but there are limitations and the level of care these patients receive outside nursing homes can vary widely. In 2017, more than 185,000 older Medicaid beneficiaries were on waiting lists for home-based care. For some, these regulatory hurdles can be too much to bear.

Many states will only pay for a few hours of personal care a day. For those with complex healthcare needs, staying at home isn’t an option unless they have someone to look after them 24/7. That’s why these individuals often end up in the nursing home instead of staying at home.

However, some patients should be cared for in a nursing home. Some households are not equipped for seniors or those with physical disabilities.

Other reasons for not aging in place include:

  • The Cost of Housing

Nearly one in five baby boomers aged 60 to 64 (18%) believe the housing options available to them are unaffordable.

According to the National Council on Aging, 64% of older Americans report that it is very or somewhat easy to pay their monthly living expenses now, but almost one in four (24%) are not confident that their income will be sufficient to continue to meet their monthly expenses over the next five to 10 years.

Medicaid only pays for room and board in nursing homes, so, in theory, seniors and those with disabilities can apply for subsidized housing instead of living in a long-term care facility. However, just 6% of rental housing for older adults in the U.S. is subsidized. Many public housing units are not equipped for seniors and those with disabilities.

  •  Access to Care

Staying at home also means relying on community-based healthcare instead of the nursing home staff. Many seniors and those with disabilities do not live in areas with fast access to doctors and specialists. Around 56% of seniors say they are satisfied with the resources and services their community offers now, and almost one quarter (23%) have little or no confidence that these resources will be available over the next five to 10 years.

Seniors often turn to family members when aging in place or living at home. Nearly nine in 10 (87%) older Americans who have a caregiver say they are receiving care from a family member. More than half of those caregivers (52%) live at home with their care recipient.

However, many seniors do not have the luxury of being cared for by a family member. If Medicaid will only pay for a few hours of care a day, these individuals have no choice but to go to a nursing home.

Nursing homes are often the most expensive way to care for older patients and those with disabilities. As the Baby Boomers continue to retire, with around 10,000 people reaching the age of 65 every single day, the U.S. will need to find another way to care for these individuals. Changes to the Medicaid system could dramatically reshape long-term care across the country.

Steven Briggs
Steven Briggs is a healthcare writer for Scrubs Magazine, hailing from Brooklyn, NY. With both of his parents working in the healthcare industry, Steven writes about the various issues and concerns facing the industry today.

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