In his May 16, 2011 article titled, Nursing Homes Seek Exemptions from Health Law“, New York Times reporter Robert Pear draws attention to the bleak outlook for Medicaid-paid long-term care (LTC).

Currently, Medicaid covers about two-thirds of nursing home residents.  Since many Boomers will soon need long-term care services in a giant bulge, the result will be a “Silver Tsunami.”  Unfortunately, very few Boomers have planned for this eventuality.

States set Medicaid rates, and many states, facing severe budget problems, have already reduced payments for nursing homes, which are also facing severe budget problems.

And now a further threat for this beleaguered system. Starting in 2014,  health-care reform will require employers with 50 or more full-time employees to offer affordable coverage or risk paying a penalty. For a mid-size nursing home, that penalty could easily exceed $200,000 a year.  Faced with increasing budget shortfalls, nursing home executives are urging Congress and the Obama administration to spare them from the penalties.

25% of nursing home workers do not own health insurance. These employees are often on the lowest end of the wage scale.

The future is not looking too rosy for nursing homes and the frail, defenseless people they serve.

With minor exceptions, Medicaid pays for long-term care only in certain nursing homes. I believe many seniors who are currently receiving LTC in these nursing homes could experience a higher quality of life in assisted living facilities, but they simply cannot afford this type of care. Why?  Because they failed to have a conversation about LTC planning while they were insurable and able to buy affordable LTCi.  So they face the bleak reality of spending their final years in Medicaid-paid nursing homes.

Since the vast majority of Boomers have not planned for their LTC, what  quality of care will be available to them when the Silver Tsumani overwhelms the available, underfunded nursing homes?  Will Medicaid funding be adequate to provide the increased demand for LTC?

In view of this bleak future they are facing, the most baffling question is: why do Boomers continue to avoid having a conversation about responsible LTC planning?