LTC Bullet: A Perspective From the Trenches

Thursday October 18, 2001

Seattle—

***This Bullet is sponsored by the National LTC Network, "Partners in Long-Term Care Coverage, Design, Education and Distribution." Visit the Network online at www.nltcn.com. Contact Allen Mansfield, Executive Director, at 800-996-6789 or AMansfi919@aol.com for more information. Thanks so much to Network members for their generous support of the Center and commitment to keeping LTC Bullets free to everyone. Won’t you help too? Go to www.centerltc.org/support/sponsor_bullets.htm to sponsor an LTC Bullet. Find out how you can sponsor other Center activities (e.g., articles, speeches, conference exhibits) by contacting Amy Marohn at 425-467-6840 or amy@centerltc.org.***

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 www.centerltc.org/bullets/current/305.htm), 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."

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