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  • Karen McPhail, RN, MSN

Virginia Medicaid Expansion and a Little Perspective!

Today I am stepping up onto my soap box for a bit...

I was thrilled to hear about the recent victory in terms of the Virginia Medicaid expansion! Now approximately 400,000 Virginians will have access to healthcare services! Then while at dinner that evening, I became deflated as I over heard people at the next table complaining, rather ranting about this. I tried my best to ignore their conversation and then I finally snapped and had to chime in politely to provide them with a little perspective.

It really makes me upset when I hear people casually criticizing those needing to access Medicaid. Many people act as if those on Medicaid are lazy, have not done all that they can, do not want to work, or just do not care. There is a significant myth out there that Medicaid recipients are able-bodied and simply not working out of choice, but that’s simply not the primary situation. People need to realize the sobering reality that they or one of their family members may in fact need to be on medicaid someday in the future.

Although sobering and unpleasant to think about ... Can you afford to pay around $85,000 just for nursing care for yourself or a loved one per year? Remember this is the average cost for just long term care, not counting other expenses, which alone is pretty much 3 times the annual income of most seniors and other individuals. If you require memory care or skilled nursing you will be paying significantly more also. Skilled nursing is approximately 3 times the average cost of general assisted living. Can you afford an expensive long term care policy (around $200,000 per person) which will probably only cover part of a maximum of 6 years of care? Most cannot... Maybe it is time to meet with your financial manager this week if you are fortunate to have one? Bottom line, if you cannot afford to pay the above you are on the road to Medicaid. Perspective...

For this reason, Medicaid is the primary payer for long term care including approximately $55 billion per year for nursing homes! Approximately 62% of those in nursing homes are covered by Medicaid. Most people do not realize that Medicare does not cover skilled nursing care, assisted living, or memory care! It does not cover any convalescent care needs, as it only covers a very limited post acute care period. So we need Medicaid funding as our senior population is growing in size and Alzheimers is a world wide epidemic effecting millions! We have approximately 47 million people effected by dementia living worldwide. The cases of dementia are expected to almost triple by 2050. 1 in 10 individuals over the age of 65 have dementia and it is the 6th leading cause of death in the US. And with this memory care is almost exclusively private pay and selective in accepting residents. To get a subsidized bed in general assisted living or a memory care facility is like winning the lottery! There are so many individuals requiring care and placement that admission is selective and grants beds are sadly limited and provided at facility discretion. Most AL facilities of course want vanilla residents without behavioral issues. Most dementia residents sadly have behavioral issues as this is part of the disease process and families wouldn't be seeking placement if things were easy. Many times these individuals are rejected by memory care centers over and over and caregivers are forced to care for them in their home with limited resources and support. As a result caregivers end up pre deceasing the ones they are caring for due to the demands of daily life, stress, and overall care management. And those in general assisted living who run out of funds often end up needing to be moved from their quiet apartment style life to a shared medicaid room in a nursing home, thus having significantly reduced quality of life. The struggle is real. The stress on families and those requiring care is at times overwhelming. Most people do not want to access Medicaid, but they simply have to!

That being said, we need to make changes in our country and start showing more compassion and less judgement realizing that more needs to be done for seniors and for those with cognitive impairments. Seniors need to be made priority. We need to also realize that individuals needing Medicaid are not lazy and to say that these people need to get a job is ridiculous and ignorant, but often times this is stated by others. The 90 year old bedridden woman with dementia clearly cannot get a job and would probably love to have a different situation than needing 24 care in a nursing home. Many seniors have worked hard and now have exhausted all of their funds paying for care no fault of their own. These individuals and their families should not be made to feel guilty about this, they should be supported.

So the next time you hear someone complaining about those needing Medicaid stand up and say something. Provide facts not platitudes. Educate them on the reality of the situation in our country for seniors, those with disabilities and suffering from cognitive impairments. There are people out there fighting the fight each day to receive necessary care and to care for their loved one’s; they deserve respect, support and the comfort of knowing that someone cares and that they can receive care and assistance without judgement.

I will not step down from my soap box...

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