LTC Bullet: A Perspective From the Trenches

Thursday October 18, 2001


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In response to this week’s LTC Bullet entitled, "Doesn’t Everyone Get the Same Care in a Nursing Home?" (10-15-01, online at, Cheryl Mitchell, an elder law attorney with 17 years experience (who also happens to be a founding member of the National Academy of Elder Law Attorneys) sent the following thoughtful reply which drives home the Center’s message about planning ahead with savings, investments or insurance to secure the best possible care. As usual, naysayers will dismiss such accounts as anecdotal or inconsistent with their own personal experience. There is, however, much evidence that Medicaid patients in many nursing facilities do not have the same experience as private pay patients. Moreover, this situation will likely worsen as continued underfunding and overutilization of Medicaid drives facilities to make tough economic choices in order to stay in business.

"With regard to your most recent column, I have a few remarks to make. Maybe the care in nursing homes appears to be the same regardless of payment status, but the overall experience may be quite different. We actually do have a nursing home here in Spokane that has a ‘Medicaid Wing.’ I told them that Washington State has a statute prohibiting Medicaid discrimination. I don't think it stopped them. This same facility has some rooms that are much less desirable than others. One of our Medicaid clients was in a room where the air conditioner blew cold air on him constantly. (He developed pneumonia and died at that facility. No, the family did not sue, but they really would have liked to have him around longer.) The nursing home told me, ‘We give Medicaid patients the least desirable rooms. The best rooms go to those who can pay for them.’

"Even if you get the same care, it can be the ‘little things’ that make a real difference in the quality of care. For example, having a telephone in one's room matters a great deal to most residents. Have your ever seen the line at the public phone in a SNF [skilled nursing facility]? Besides that, there's no privacy. The ability to have some ‘spending money’ for the beverage cart that comes around in the afternoons is a big plus. There are lots of examples of the little extras that make life so enjoyable, I need not say more.

"Unfortunately, not everyone has the option to pay privately, but it's something to think about."