This Washington Post story describes why our system is incentivized to discharge patients when they are still very needy, but their Medicare-paid re-hab benefits are exhausted. Medicaid can then often pick up costs, but it pays facilities poorly. This incentivizes facilities to admit the least needful and costly patients. In addition, “The Medicaid system is overly cumbersome and too slow to provide benefits.”
The true heroines of long-term care, paid home care providers, earn an average of $10.11 an hour, states this September New York Times article. About a third of these caregivers rely on food stamps and 28% rely on Medicaid for health insurance. Annual caregiver job turnover rate is 40-60 percent.
The article continues by stating caregivers at Medicaid-funded facilities got their pay raised to minimum wage: $7.15 per hour last year. Such caregivers are often overwhelmed with the sheer number of patients they must care for. “Ms. Walker left her job at a nearby nursing home because “sometimes you had 12 to 15 people to take care of,” she said. “You’re trying to feed everybody, give them baths, but a lot of people got neglected.”
This testimonial about Medicaid’s flaws on the receiving end of care is heart-wrenching, “When Roy Potter was weakened from postpolio syndrome and his wife, Joan, could no longer help him out of bed, a nursing home was “unthinkable,” said Ms. Potter, 83.
For a year, they paid private aides $14 an hour to come to their home in Mount Kisco, N.Y. When they could no longer afford that, Mr. Potter qualified for Medicaid, which pays the preponderance of home care costs in this country.
Over the next two and a half years, more than a dozen agency aides — some caring and competent; some not; some disappearing without explanation — cycled through their home, as did a number of short-term substitutes.
“A new person would come, and I’d have to walk them through everything all over again,” Ms. Potter said.
She grew increasingly anxious about whether an aide would show up. “Every morning I’d hold my breath until the doorbell rang,” she said. “Several times, I had to get in the car and drive to the agency and say, ‘Who is coming today?’”
Last year, when federal overtime provisions took effect, the agency cut back helpers’ hours.
She and her children succeeded in keeping Mr. Potter at home until he died in April, at 86, but finding and keeping help proved a continual battle.