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New York Times, March 4, 2019: Nursing Homes Are Closing Across Rural America, Scattering Residents
The NYT article discusses some of the heart breaking individual cases for many who live in rural America. Finding a nursing home close to where family and friends live is increasingly difficult because many of them are closing for lack of trained staff and profitability.
"More than 440 rural nursing homes have closed or merged over the last decade, according to the Cowles Research Group, which tracks long-term care, and each closure scattered patients like seeds in the wind."
"Home health aides can be scarce and unaffordable to hire around the clock. The few senior-citizen apartments have waiting lists. Adult children have long since moved away to bigger cities."
The reasons for the closings include failure to meet health and safety standards, but the majority are financial -- changing health care policies that now encourage people to choose independent and assisted living or stay in their own homes with help from caregivers. That in itself should be considered a positive, but as occupancy rates in the nursing homes fall and more of their patients' long term care is covered by Medicaid, they lose money.
In South Dakota, a conservative state, nursing homes are being shut down or are losing money because the majority of their residents rely on Medicaid. They lose about $58 per day for each resident because of stingy reimbursement rates. At those low reimbursement rates, the nursing homes cannot find staff that will accept the low-paying work of caring for frail residents and remain profitable.
I mention this because Bernie's Medicare for All provides for long term care with expanded Medicaid, but the states will still be expected to share in the costs. However, one of the selling features of MFA is to cut salaries and fees of the healthcare providers to be more in line with existing Medicare and Medicaid reimbursement rates. For those nursing homes now providing long term care for the more profitable private patients, those patients will instead be covered under MFA cost structure...no more private patients. All patients will be covered by Medicaid.
For us baby boomer generation the problem will only get worse, but maybe not for those of us living in urban environments. I can foresee in the urban environment where many of these nursing homes will become private, essentially opting out of "Berniecare" and not accepting Medicaid patients at all. That would leave the few Medicaid nursing homes like those in rural areas as low cost operations with inadequate staff.
The obvious solution is to increase the Medicaid reimbursement rates, but under Sanders MFA increasing the fees will be difficult when at the same time under the new system administrators will be charged with keeping costs under control as promised by Bernie.
I don't know if Sanders has considered this trend, but I do know that he feels that the healthcare industry itself is too profitable and part of his many selling points is to rein in the costs of health care providers. Making a profit on health care is essentially seen as obscene. He has said that on many occasions.