LTC Bullet: Why Nursing Homes Evict the Poor Elderly

Monday, February 9, 2009


LTC Comment: More nursing homes are giving Medicaid residents the boot. Who's to blame? The answer after the ***news.***

*** SAVE MEDICAID LTC CAMPAIGN. We've begun to reconfigure the Center for Long-Term Care Reform's website at to reflect the Center's 2009 focus on saving Medicaid LTC for the needy. Last year's "2008 National Long-Term Care Consciousness Tour" is no longer front and center, but you can read all about it and see pictures just one layer down. "Under construction" is our new web presence focused on saving Medicaid for people in need by fixing Medicaid eligibility rules, maximizing non-tax revenue to state Medicaid programs, and encouraging responsible long-term care planning. Visit now and often to follow our progress. ***

*** SILVER BULLET opportunity. I'm bringing the Silver Bullet of Long-Term Care to Reno, Nevada for the 9th Annual Intercompany LTC Insurance Conference (March 29 to April 1, 2009, details and registration at Call it the "2009 LTC Consciousness Mini-Tour." The Western Region got short shrift on last year's Tour and I'd like to correct that this year. So, if you can work with me to schedule an event anywhere in the LTC Tour Western Region (CA, NV, OR, WA, ID, MT, WY, CO, UT, AZ, NM), I'll bring the Silver Bullet to you and we'll do a day of training, media, publicity and speaking . . . including the LTC Graduate Seminar if you wish. If we can schedule this on a reasonable itinerary and timetable, between mid-March and the end of April, we can make it happen for as little as $500 per sponsor. And you may qualify as a Regional Representative of the Center for Long-Term Care Reform too! Initial inquiries to Damon at 206-283-7036 or But act fast. Days and time slots will go fast. ***

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LTC Comment: The Seattle Post Intelligencer ran this story Saturday: "Even elderly are facing eviction: Complaints on rise of nursing homes forcing out residents." Read the following excerpts or the whole article at Then come back for our analysis.


Excerpts from: Vanessa Ho, "Even elderly are facing eviction: Complaints on rise of nursing homes forcing out residents," Seattle P-I, February 6, 2009,

"As health care costs rise and Medicaid rates lag behind, nursing and boarding homes are forcing out sick, elderly and frail residents in what advocates say is a growing trend. No official data exist on eviction counts, but discharge complaints have climbed to record highs. . . .

"[The state LTC Ombudsman said] 'When (homes) can find an opportunity to discharge the person, they will. The problem is especially hard with nursing homes, because where else are they going to go? It's the end of the line.' . . .

"Homes can legally evict a resident who fails to pay, becomes dangerous or has needs a home can't meet. Boarding homes can evict Medicaid residents by slashing public-assistance beds, but federal law bars nursing homes from kicking out residents solely because of Medicaid.

"But advocates say many homes find ways to bend the laws. They say homes mislead families to lure in residents, and use the broad 'can't meet needs' reason to force out difficult or expensive residents. . . .

"One of the most common types of eviction is when homes send a resident to the hospital and refuse to take him back, in a practice that resident advocates call 'dumping.' . . .

"Advocates counter that dumping rarely occurs to private-pay people, but to Medicaid residents . . .

"The eviction left Arnold with one stressful option: a nursing home 45 minutes away -- too far for regular visits from friends and family. . . .

"Other families have felt deceived by boarding homes that promised Medicaid beds and later reneged. Or by nursing homes that discharged residents with advanced Alzheimer's disease, after touting expert dementia care. . . .

"Doug Campbell recalled asking the administrator of his mother's Port Townsend boarding home what would happen when his mother's money ran out. '(The administrator) said, "As long as I'm here, your mother will not have to move,"' said Campbell, a retired teacher.

"But the administrator soon left, and the home -- Victoria House -- evicted his deaf, blind, 97-year-old mother soon after she converted to Medicaid. . . .

"He [Gary Weeks, Executive Director of the Washington Health Care Association, a provider trade group] said the more pressing problem is the growing gap between care costs and Medicaid payouts. Medicaid caseloads have also grown, because people are living longer and baby boomers are aging into long-term care.

"With assisted living costing residents $3,000 to $6,000 a month, and nursing homes costing up to $10,000 a month, homes lose money daily on each Medicaid resident, Weeks said. On average the state pays out about $5,000 a month for a nursing home resident, and $2,000 for a boarding home resident.

"To survive, nursing homes are seeking out residents with better coverage, he said."


LTC Comment: To summarize: More and more nursing and boarding homes are throwing out difficult or expensive patients when they convert to Medicaid.

Sounds like another story about greedy LTC providers feeding profits by starving care. But is it that simple?

Who's really at fault?

Medicaid reimburses nursing homes less than the cost of providing the care: $4.2 billion too little in 2008 or $12.48 per patient day. Yet Medicaid reimbursement touches nearly 80 percent of all nursing home patient days. What's worse, most long-term care is provided in nursing homes instead of in the home or community because Medicaid still has a heavy bias toward institutional care. Add in the current financial crisis which has state Medicaid programs cutting back on services all across the country. No wonder care access and quality are deteriorating.

What we need is more people paying privately at market-based rates. That's what Gary Weeks of the Washington Health Care Association meant by his statement that closed the article: "To survive, nursing homes are seeking out residents with better coverage."

So, why don't more people pay privately for long-term care? Why don't they tap their home equity through reverse mortgages to pay for long-term care? Why don't more of them own private long-term care insurance?

You guessed it. Medicaid is not only unable to pay for quality long-term care in the most appropriate settings, it simultaneously crowds out the only solution to the access and quality problems--more private financing.

Here's how it happened. Medicaid made nursing home care free in 1965. That stunted the private markets for home and community based care and insurance to pay for it. Over the years, costs exploded beyond the government's ability to fund Medicaid. As P.J. O'Rourke likes to say: "If you think health is expensive now, wait until it's free." 44 years later we find ourselves at the end of this rope. Most people don't worry about long-term care until it's too late to save, invest or insure. Then they or their heirs take advantage of Medicaid's generous and elastic eligibility rules. And that means they're stuck with whatever Medicaid provides: less and less of worse and worse underfunded care.

But we're in the end game now. The safety net that's been there for decades softening the fiscal consequences for uninsured people who need long-term care is disappearing. If the current financial crisis isn't the coup d' grace, the aging of the baby boom generation will bring it soon.

Anyone who advises aging Americans about financial planning should see stories like this one as a peek through the windshield at what's coming. Use this story and hundreds more like it in coming months and years to cut through your prospects' and clients' denial. You are their front line of defense against a rapidly approaching disaster. You have a moral and fiduciary duty to wake them up and get them protected. Don't use scare tactics but recognize this:

With all the anesthesia about LTC risk that government has pumped into the body politic for decades, you will need strong medicine to shake folks out of their stupor. You'll find that medicine here every day, in LTC E-Alerts and LTC Bullets.