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THE NURSING HOME FUNDING CRISIS
Lauren Anderson | Oct 15, 2019
Topic category: Caring for our Heroes
FROM:Biz Times

In April, Julie Thauer’s 91-year-old mother, Nancy, suffered a stroke, and her assisted living facility could no longer provide the services she needed. She had to move.

Once she began researching her options, Thauer, a Shorewood resident, was confronted with a number of roadblocks.

Thauer’s mother, a woman she describes as a 1950s homemaker who went on to “do her best to live on what she had” after her husband died, had run out of money to pay for her long-term care, left to rely solely on government assistance.

When Thauer attempted to get her mother into a 5-star rated nursing home facility, as measured by Centers for Medicare and Medicaid Services, she was turned down because of her “payer source.” The implication was that the facilities preferred a private payer, as opposed to government-funded Medicaid, which reimburses nursing facilities at below cost. Medicaid is a federal and state government program that covers medical costs, including nursing home care, for people with limited financial resources.

Lower-rated facilities presented other challenges. Thauer had concerns about quality, and they were farther away from her than she preferred. One turned Thauer away, citing a recent influx of patients from another area nursing home that had just closed.

She was left with few options.

“What I was told is, ‘You’re not going to be able to get into a five-star (facility). You’re going to have to accept a one- or two-star,’” Thauer said. “But if you’re looking at someone needing 24-hour care and they have bedsores, you’re sentencing them to death. Money is what makes the difference.”

Thauer’s experience underscores the financial challenges faced not only by families seeking care for their loved ones, but also an industry that’s up against serious headwinds, including low government reimbursement rates, a severe workforce shortage and a swelling patient population.

As of August, 12 Wisconsin nursing home facilities have shuttered their doors, or are in the process of closing, this year alone.

Wellspring of Milwaukee, a 185-bed rehabilitation and skilled nursing center on the city’s northwest side, closed in March, forcing the relocation of its residents and elimination of 160 jobs. The facility’s notice filed with the state Department of Workforce Development attributed the decision to “catastrophic unforeseeable business circumstances.”

In April, eight Dycora Transitional Health & Living skilled nursing facilities in Wisconsin, including two Glendale locations and a Greendale location, were placed into receivership, an alternative to bankruptcy under Wisconsin state law.

Milwaukee-based Fortis Management Group, which operated 65 long term care centers in six states, also filed for receivership in July 2017, ultimately closing its Milwaukee headquarters and laying off 250 employees in fall 2018.

A total of 34 facilities in the state have either closed, or are in the process of closing, since 2016. Medicaid losses are a significant contributing factor, industry representatives say.

“Reimbursement for Medicaid services has never been particularly lucrative,” said John Vander Meer, president and chief executive officer of the Wisconsin Health Care Association and Wisconsin Center for Assisted Living. “But in the last 10 years, there has been an increasing payment gap between the level of reimbursement that skilled facilities receive on a per-patient per-day basis, compared to the cost they sustain.”

But even as increasing acuity levels lead to higher costs for facilities, the state has largely seen minimal increases in the Medicaid reimbursement rate over the past decade.

“Arguably our gap is higher than most, but I don’t think there’s any provider out there that’s not losing money with Medicaid,” Sattell said.

That means cost-shifting onto private payers. “It’s a delicate model,” said John Sauer, president and CEO of LeadingAge Wisconsin. “Facilities are looking at what is the maximum number of Medicaid residents they can serve and still be able to meet their budget, make payroll, staffing wages and benefit needs within the organization. What I think people are starting to realize, because Medicaid has been paying at such a low rate compared to cost, is that there is starting to be access issues for someone on Medicaid needing nursing home care … We’re seeing that in many areas of the state.”

Workforce ‘crisis’

Compounding the issue is a serious labor shortage amid a sustained low unemployment rate in recent years. In 2018, a survey of about 750 nursing home and assisted living care providers in Wisconsin found the state’s long-term and residential care facilities had about 16,500 vacancies for caregiver positions. The survey was released by a coalition of senior-serving organizations, including LeadingAge, Wisconsin Health Care Association, Wisconsin Center for Assisted Living and Disability Service Provider Network.

In that same study, about 83% of providers said there were no qualified applicants available for their key positions. Over half said they had not received any applicants for openings.

“It’s appropriately called a crisis,” Sattell said. “We know we’re not alone in terms of the difficulty finding people and keeping people in this low unemployment economy.”

Understaffing has hampered Ovation’s ability to accept new patients, hurting its bottom line.

“There have been times when we’ve not been able to take in admissions,” said Michelle Putz, chief operating officer. “We have to make sure we have enough people on staff to take care of people. We’ve had to limit admissions; that’s financially affected us.”

“Our employees work very hard; it’s very stressful being in caregiving jobs,” Putz said. “They need to be celebrated, so we’re trying to find more ways to do that.”

For operators, Putz said, the stakes are high when it comes to employee burnout and turnover. More than ever, nursing facilities need well-trained workers to deal with an increasingly complex patient population.

“We’re a 24-hour business; we’re taking care of a vulnerable population,” Putz said. “In the last three to five years, the population has been more sick and coming in with more complicated social, economic and family issues. We need expertise. So how do we retain those folks who might not want a traditional 40-hour work week? We are taking care of a much more complicated resident population than ever before.”

That’s only expected to increase, Sauer said.

“As we age as a population and boomers move from ages in the 60s to 70s and 80s, the demand for skilled nursing facilities is going to increase,” he said. “Nursing homes will look different than they do now … Many hospitals are telling us they’re having a very difficult time placing certain individuals in nursing facilities.”

“We’re a person-centered business,” Vander Meer said. “You can’t get a machine to hold your grandmother’s hand when she needs to be comforted from a spell of dementia … These aren’t widgets; they’re people. And we have to have people who are well-trained and well-equipped and well-oriented from the standpoint of being the right caregivers to offer that care.”

_______________________________________________________

Kiplinger – October 8, 2019

https://www.kiplinger.com/article/retirement/T036-C032-S014-get-your-head-out-of-the-sand-about-long-term-care.html

LONG TERM CARE – THE HIDDEN RISK THAT COULD PUT YOUR RETIREMENT IN JEOPARDY

Baby boomers are living longer than ever before. In fact, as a nation, we are getting grayer and grayer. The U. S. Census states that, “Already, the middle-aged outnumber children, but the country will reach a new milestone in 2035. That year, (they project) that older adults will edge out children in population size: People age 65 and over are expected to number 78.0 million, while children under age 18 will number 76.7 million.”

Many baby boomers have remained ignorant of the challenges of living longer and of the need to make the necessary preparations for this phenomenon. Have baby boomers saved enough to take care of themselves as they age?

The simple answer is: no.

The Insured Retirement Institute in a 2018 study found that “42% of baby boomers have nothing saved for retirement. Among boomers who do have retirement savings, 38% have less than $100,000 saved for retirement. Further, (only) 38% have calculated the amount they will need to retire.”

A Glimmer of Hope for the ‘Silver Tsunami’

The Bankers Life Center for a Secure Retirement released research titled A Growing Urgency: Retirement Care Realities for Middle-Income Boomers.

It found that Boomers’ awareness for their aging and the associated costs is beginning to take hold. Scott Goldberg, president of Bankers Life, told me that, “While some people hope to live to age 100 or even longer, the cost of caregiving associated with living longer can still come as a surprise. However, it should be a non-negotiable in any retirement plan. As more Boomers are becoming caregivers for their parents and loved ones as they age, they are beginning to face the realities of caregiving first-hand, including the financial sacrifices that many caregivers must make to provide necessary care. The study shows that among the top five sacrifices Boomers are willing to make to provide care, the top two are reducing other spending (66%) and traveling less (41%).

Who Picks Up the Tab?

Boomers are now picking up the tab for caring for their loved ones. According to the National Academy of Social Insurance, “Today, billions of dollars’ worth of care is provided without charge by families whose members give up time and money to willingly help their loved ones. But many of the baby boomers won’t have these kinds of helpers, and may ultimately demand their fellow taxpayers to foot the bill for hiring caregivers. Millions of boomers won’t have spouses or children to rely on when they become infirm and struggle to stay out of nursing homes.”

You can’t count on the government to pick up the bill. Medicare will pay for the cost of medical services offered in long-term care facilities, but they DO NOT pay for the cost of “any type of long-term care, whether in nursing homes, assisted living facilities or people’s own homes,” according to AARP.

One Size Doesn’t Fit All

There is no one solution to aging with dignity and care. An AARP survey found that “75% of boomers have not factored health care costs into their retirement savings goals, and 85% haven’t included long-term care costs. Even for the 29% of boomers who consult with a financial adviser, only 52% have included health care and 36% have included long-term care in their planning.”

It’s time to start planning and include your adult children in that conversation. Some options to consider include:

Long Term Care Insurance

This is insurance that will help you to cover many services that are not covered by regular health insurance. According to NerdWallet, “Most policies will reimburse you for care given in a variety of places, such as:

  • Your home.
  • A nursing home.
  • An assisted living facility.
  • An adult day care center.”

You really need to buy this as you get into your 50s-or 60s, or you may not be able to qualify, or the cost could be prohibitive.

Short-Term Care Insurance

Short-term care insurance is usually a policy that covers the same costs as associated with long-term care, but will be for a shorter duration, for instance three months to a year.

Life Insurance with a feature called an Accelerated Death Benefit

Most whole life insurance policies will give you an option of an accelerated death benefit, where you can “take a portion of the life insurance payout while you’re still alive to pay for medical expenses, including long-term care. The death benefit is reduced by the amount used for long-term care.”

Sell your life insurance policy

You may have a cash value built up in your existing policy and it may make sense to surrender it and get the cash value (it will be less than the death benefit) and use that money to help to pay for long-term care. Obviously, when you do die, your loved ones will no longer receive any death benefits.

Immediate Annuity

This is an annuity that you buy, and it carries a return as the financial institution will also pay you your principal back. Think of an immediate annuity as sort of working like a pension. You will need a large amount to invest (usually $50,000 or more). If you are in poor health, you will probably get a higher annual payout than if you are healthy. This is because the insurance company, if you are healthy, will have to pay out over your remaining life (which could be a long time), or they can pay for a set period of time.

Medicare Home Health Care

Medicare will basically pay for short-term care, for instance after a fall or a surgery. You have to qualify for the services to be provided. They do not pay for custodial care for instance, if you are diagnosed with Alzheimer’s or cancer, etc.

Don’t Try This at Home

Don’t try to navigate the financial waters by yourself. There are professional financial advisers out there who will help you to sift through all of the options. You really need to analyze your current financial situation; your savings; your current lifestyle; and most important, your desires. What do want your later years to look like? Do you want to be at home? Are you fine with a nursing home?

When you get a handle on all of that, it’s time for your investment planning. That may involve cutting back now to assure you and your loved ones will have an inspired way forward that excites you all and that won’t make you jolt up in the middle of the night in a cold sweat.

I love the words of Betty Friedan, who was a supporter of the First Women’s Bank, while I was president; “Aging is not lost youth but a new stage of opportunity and strength.”

SOURCE:
Lauren Anderson |Oct 15, 2019
FROM: Biz Times
Tags: Funding Crisis, Nursing Home, Medicaid, Wisconsin Health Care Association, Wisconsin Center for Assisted Living,
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Tell the NY Dept. of Health to STOP the Devastating Cut to Nursing Homes
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Are you a caregiver? IT’S TIME TO SPEAK OUT!

New York’s Dept. of Health has changed the way it pays nursing homes. As a result, nursing homes face a huge cut. Some will close. Others will reduce staffing. Jobs will be lost. The quality of care will decline.

Who will suffer the most?

The vast majority of nursing home residents and the direct care workers who look after them.

We’re calling upon all concerned caregivers to speak out against this wrong. Please click the link and join the thousands of New Yorkers other concerned citizens calling to STOP THE CUTS.

Tell the NY Dept. of Health to STOP the Devastating Cut to Nursing Homes