Helpless, Old and Abandoned

With all the focus on the Federal tax rate it’s easy to lose sight of one simple fact– the money for essential services has to come from somewhere. When the Feds cut services the State taxes go up. The Tampa Bay Times explains why the Romney campaign’s proposed Medicaid cuts will come down hard on the middle class. Boomers who think that only the young and poor depend on Medicaid may be in for a shock if the parents ever need to go into a nursing home…

People think that since Medicare covers medical services for people over 65, it also pays for nursing home care for elderly people. Medicaid is thought of as a poverty program that provides medical coverage to poor families. But Medicaid is the program that provides long-term care to the elderly and disabled, which accounts for 31 percent of the program’s $400 billion annual federal and state spending. Most of the nation’s 1.8 million nursing home residents, including more than 77,000 Floridians, rely on Medicaid to pay their bills.

Nursing home costs can exceed $80,000 a year. How can this be so costly? Here’s an inside take on it.

I started up the nursing ladder as a nurses aid in the 1980’s– what an eye-opener. Back then there was lots of sanctimonious talk about ungrateful children who shove their parents into nursing homes instead of caring for them at home. My first day on the job completely undid that nonsense.

The physical labor of caring for people who cannot care for themselves is almost impossible to believe if you have not been there. Three shifts 24/7/365 are required, and workers have to be competent, trustworthy and trained. Immobile people have to be turned every 2 hours to prevent bedsores, incontinent people have to be changed and continent helped to the bathroom. Some have to be fed by hand patiently, because they have little appetite. Some are prone to choking and many have special diets. You can’t mix up the trays without risking harm. Some are mobile but so confused they have to be constantly watched. Nurses and med techs rush around with pills and shots and tube feedings and ointments. It’s flat-out busy all the time.

In the ’80’s you learned on the job, and nurses aids were not certified. The nursing home I worked in was later closed after a temp worker put a woman into a tub without checking the temperature and burned her to death. After that, Rhode Island law got stricter. When I started it was routine to tie patients to chairs and beds– no more. Bedsores were common, I saw many unfortunate elderly end their lives with sores so deep you could see the bone. Now that’s something a facility gets penalized for. Anyone who wants to solve the cost problem with de-regulation needs to know we’ve been there and done that and it was nasty.

Workers who want a nurses aid certification may spend about $350 and months of classes, and if they fail the final exam it’s all money down the drain. This is for a tough job at low wages, sometimes without benefits. I met plenty of workers who delivered health care but had no way to afford it themselves, and this, to me, is a disgrace.

Costs can only be cut so much. Big players like nursing home chains have to be watched closely, because they have a mandate to maximize profit while staying within the letter of the law. A typical nursing home has flowers in the lobby, but the real picture is on the third floor– they’re kind of a Dante’s Inferno in reverse.

I don’t know what the answer is, besides staying healthy and open minded about our options. I do know that nursing home care doesn’t come cheap, and even if Mom sells her house and lives in a trailer, she won’t be able to support Dad in the nursing home indefinitely if he insists on staying alive. Their kids, who at this point are trying to put their own kids through college and save for their retirement can’t raise an extra $80,000 either. Medicaid for long term care is universal and under the radar. It ain’t broke, yet.

But if Medicaid is cut too far, the middle class will feel the pain. That’s not even including cutting young adults and children off the rolls. This will affect low-wage workers like the nurses aids who are caring for the elderly.

The truth is, we are one country and the 47% include workers who help the 52% manage their lives. The 1% don’t have to worry, and unfortunately they are running the country and lecturing the rest of us about austerity.

Ask not for whom the budget cuts, that’s your safety net that just went South.

Read more of this startling reality-check at the Tampa Bay Times.

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