4/10/2012 6:20 PM ET|
The coming nursing home shortage
Construction of facilities is declining, and the federal government has cut Medicare reimbursement rates. As seniors increase in numbers, expect elderly care to suffer.
The latest casualty of the Great Recession may soon be the nation's elderly. Cuts in government payments for patient care and less construction of new nursing homes are already taking a toll. Add to this the aging baby boom generation, and you have a worst-case scenario in which older people who need full-time care won't be able to get it.
"We believe we're at a tipping point," says Mark Parkinson, the head of the American Health Care Association, which represents nursing homes.
If so, the timing couldn't be worse. The first baby boomers hit age 65 last year. By 2030, 20% of the U.S. population will be at least 65, up from 13% today. In that same period, the number of 85-year-olds will increase more than 50%, and the number of 100-year-olds will nearly triple. But the number of nursing homes dropped almost 9% from 2000 to 2009.
Nursing homes and hospitals are places that everyone wants to avoid -- until they can't. Most people say they want to age at home, but as retiring boomers get older, more will need the type of 24-hour care that only a nursing home or hospital can provide. That's because the prevalence of chronic illnesses like Alzheimer's disease, cancer and diabetes increases with age. Fifty-five percent of all cancers are diagnosed in individuals 65 and older, and by 2030, 7.7 million of those 65 and older will suffer from Alzheimer's, 50% more than today, according to the Alzheimer's Association. By 2025, the number of those 65 and older with diabetes is projected to almost double to 10.6 million.
Several trends are cutting into the number of nursing homes. Many homes were constructed during the 1960s under President Lyndon Johnson's Great Society programs. Often those homes are closed because they are old or, with their long hallways and large, multi-resident rooms, don't fit what current residents want, says Robert Kramer of the National Investment Center for the Seniors Housing and Care Industry.
But the recession has made getting private financing for new nursing home construction tougher. From 2007 to 2011, the number of under-construction nursing home units (the sections of a facility that provide only nursing care) declined by a third. "I cannot tell you of anyone who has actually developed a new skilled nursing facility in at least the last five years in California," says Edward Steinfeldt, a consultant to developers of retirement housing and health care.
And existing nursing homes are struggling. They have long lost money on patients whose stays are covered by state-run Medicaid programs, which pay for long-term care for chronically or terminally ill patients who have run out of money. According to a recent report by the AHCA, in 2011 nursing homes lost at least $20 per Medicaid resident per day nationwide. Total losses came to $6.3 billion nationally, the highest yearly total ever, with higher deficits to come next year, according to the report.
Making matters worse, last year the federal government also cut its reimbursement rates by 11% to nursing homes for Medicare patients -- people released from hospitals to nursing homes who need short-term care to recover from injuries or acute illnesses. That's a huge hit, because Medicare payments are responsible for more than 20% of nursing home revenues. (Medicaid provides about 50% of revenues, and most of the rest comes from private long-term care insurance and people who pay out of pocket.)
For the 187-bed nonprofit Lutheran Home in Milwaukee, which has gross receipts of about $20 million, the Medicare slash will take $700,000 to $750,000 off the organization's bottom line this year, says CEO Scott McFadden.
The real-estate crash has added to nursing homes' budget crunch. Many clients sell their homes and use the money to pay out of pocket for long-term-care services from a nursing home. By obliterating more than $8 trillion in home equity, the collapse cut the number of patients who can pay their own way.
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I work in a healthcare & rehab center and I would like to add my two cents.....NOT ALL facilities are as bad as these people are commenting. I see SO much love and compassion where I work! The aides and nurses clearly LOVE what they do and it shows. No one wants their parents or loved ones to end up at a nursing home but unfortunately sometimes that is the only option. I see residents that are left here by family and have no visitors..truly devastating...BUT then I see the aides that consider those people family. I see the aides break down and cry when one passes. I LOVE my job and hope that with turn of events, these facilities remain.
You ought to get your facts straight. Try educating yourself, it helps. The article was very accurate. Being a baby boomer, I am stunned at the costs of care for the elederly. Unless you can afford the kind of supplemental insurance that covers RX meds and whatever medicare doesn't pay, as well as long term care, be it at home or in a facility, if and when needed, you will spend every penny you have (selling your house and spending all your retirement savings) to cover these insurance costs. forget dental...We have the highest costs in the world for health care (almost double the next highest costs), and still we have 10's of millions(upwards of 50 miliion)people have no access to primary care. More and more seniors are falling into the higher numbers, not affording those costs, with nothing but declining quality of care, and more cuts coming.Those stats given in the article give you an idea of where we're headed unless something drastically changes for the better. The costs of building more facilities are astronomical and corporate money is not going there (except of course facilities that cater to the wealthy). there are much more profitable ways to increase your billions then building nursing facilities..
With the pressure on the Bankrupt US Gov to cut back spending on both medicare and medicaid (unless it comes to the war machine-always money for that), we are looking at something horrific when millions of poor people will literally be in the street, or in miserable facilities with caregivers having to stretch the numbers to give any kind of basic health care for seniors over the next 10-20 yrs. Our friends on the right side of the political aisle are not concerned..."Entitlements" they are called. let them die.They, on the other hand, are all covered for life with that horrible Gov health care paid for them from our tax dollars. besides the fact they are wealthy to boot. Do more homework Tyrone and show me your facts and figures. This is isn't x-box 369, American Idol, or dancing with the stars.
set my bills on automatic, and leave me alone.When it is my time, it is my time. I would rather a cave in the woods than a nursing home.
My mother just passed in one of these Assisted Living homes. The residents called it "God's waiting room" as they feel that they are merely being warehoused until they pass. For $5,000 per month, mother received a 1 bedroom, 1 bathroom apartment and 3 meals a day. It would have been cheaper to have placed her on a cruise ship. At least there the food would have been better and the cost considerably less. But I digress, over 3 years I saw the company change hands twice and the staff reductions were constant. They cut costs further by reducing the quantity and quality of food. Personally, I have it written in my estate plan that if the family must choose between a nursing home or letting me die than they are to withhold all medications except pain medications and let me die. No way in screaming blue hades I want to pay for the privilege of rotting away in one of these places.
I too worked in the long term care industry as a dietary manager and I have seen both end of the spectrum. Those who are recieving federal funded medicare patients have more of a choice in placement. Those who are on medicaid which is state funded, tend to get the left overs.
These baby boomers should have thought twice about who they put in office 20 and 30 years ago.
There are many clients in nursing homes who can take care of them selves. They feed themselves,can walk around. talk OK. Assisted living places would suit them fine. Home care is a better option. Leave nursing homes for the very ill and those totally unable to care for themselves.
What this article says is that there is going to develop a TWO TIER system for Nursing Home long term care, just like what is going to happen with the rest of our health-care system if the ACA (i.e. Obamacare) stays in force. This is going to be the "Government Controlled/RUN", Single-Payer, Medicare tier for the "Poor" and those that have exhausted their families resources, and the second tier for the "Evil Rich" that planned for and took responsibility for themselves by saving for retirement, have private insurance, and can pay "out of pocket".
The "Medicare, Government, Single-payer" tier will have inferior care, rationed services, limited treatment options, medication limitations, and High occupancy housing configurations; ( for those of you that have never been under a socialized Government single-payer health--care system, that means you are housed on an OPEN WARD of 50 to 100 beds with One "nurse" or Orderly, NO PRIVATE OR EVEN SEMI-PRIVATE ROOMS. If you are classified and "ambulatory" you will be required to assist the staff in care of other patients, i.e. empty bed-pans, feed, bath, clean, etc.). The government "bean-counting" bureaucrats that will run this system will enact Euthanasia policies and panels, (Oh, Um I mean End of Life Counseling Panels according to the ACA), All of these measures will be implemented to "Control Costs".
The "Private Insurance" tier will be much as it is today, with private/semi-private rooms, Day rooms, Activities, Full Medical staff and facilities on-site, etc. These Facilities will not be "Medicare Certified" or accept Medicare/Government system patients. You can stay as long as you can pay.
There is no such thing as a "FREE lunch". Nothing is ever "FREE". In order for the Government to give someone something for "FREE", like say "Birth Control", they have to TAKE twice the Cost of that from someone else, because of the inefficient bureaucratic overhead inherent in ALL Government programs.
This is the "HOPE and CHANGE" you voted for. Hope the Democrats don't steal all you hard earned money, and Change the President in 2012.
This is not completely correct - many states have adult foster home programs which can meet the same needs as a nursing facility at about 1/3 the cost. This community based care is supported under Medicaid Waiver 1915C for those states that apply. Adult foster homes provide a home like environment so people feel they never left their home. They receive more personalized care in a warmer, non-institutional, setting.
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