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What can be done to keep you, your elderly relative, out of a Nursing Home?

What can be done to keep you, your elderly relative, out of a Nursing Home:


In the alternative, how is it that you can defer, delay and/or ELIMINATE ENTIRELY the need for Nursing Home Care, this in the age of lump sum payments to hospitals (for the most part, and by Medicare, in every instance, virtually): thus raising the various (to be discussed here) plans that can be put into place, a sort of MEDICAL ESTATE PLAN: this publication will in the weeks and months ahead, review and demonstrate, how you can avoid, or avoid for the most part, ANY Long-Term Nursing Care, whatsoever !!




(During The 2012 Presidential Contest: THIS WAS A HOT TOPIC, Sometimes):  Recently, it brought me back to the issues discussed herein.  Each is designed to help families and individuals rely on Nursing Homes as a principal part of the care an elder needs, say, post any Acute Care Hospitalization: such as that discussed in our previous blog, i.e., the blog publication, immediately preceding this blog, this issue.


A few days ago I received a call from a long-standing friend from our junior-high days in Louisiana.  Since I had represented him in his claim for Social Security Disability, I knew the specifics of his ‘case’ rather well.  His questions were revealing, however: what do I do when I am this next week having all of my MEDICAID services re-evaluated by the Louisiana’s local Medicaid/social services agency?  Simply put, my friend lives on, exists only by enjoying a long-standing program, principally funded by the federal government, and which is sometimes, and in most states, referred to as the “Medicaid Nursing Home Waiver Program”.


Simply put, the idea goes back several decades, to a program long ago started in New York State, and then referred to as the “Nursing Homes Without Walls Program”.  Its principal goal is to keep many who would otherwise be cared for in a Nursing Home, at home, and thus NOT institutionalized, in any way.  The program works like this:


First, a patient must be evaluated and found eligible for Nursing Home Care, i.e., there is clear medical evidence that the legal and medial threshold exists for State Medicaid to fund, in whole or in part, such Nursing Home care for a given patient, and future Nursing Home Resident.


Next, under a Federal Medicaid Waiver from the ‘feds’, states are permitted to arrange similar care at home, and often at a fraction of the cost of what institutional care (such as that provided in a Nursing Home, and paid for by Medicaid, either in whole or in part) with one fundamental requirement: the would-be Nursing Home resident must be shown to be of sufficient well-being, such that with the proper medical and social services support, on an outpatient basis, all medical and social services care required can then be delivered to the would-be Nursing Home resident at home: i.e., the patient’s, the would-be resident’s home: meaning, most often, right where they are living at the time such a ‘waiver’ is requested by local Medicaid officials.  If not their home, many of my clients have found their new life to be, often, in the home of a daughter, or other family member: for all of the future, or until the elder can regain her strength, her stamina, to return to her own home.


Often overlooked in the last presidential debate, was the subject of “returning Medicaid to the states” e.g., per the suggestion of Governor Romney.  NOTE:  Even though MEDICAID is administered locally by the individual states, Medicaid is, really, a federal program: in fact, it is Title XIX of the Social Security Act.


In a poor state like Louisiana, the Louisiana Medicaid Program is funded by a combination of federal Title XIX dollars, with a percentage “match of state/Louisiana dollars”: but in every case, whether institutionalized care, or in-home Medicaid Waiver Care, the vast majority of the funding for these persons’ care, is the responsibility, since 1965, of the Federal Government, this as part of LBJ’s Great Society initiatives.  In fact, it was a little thought out part of the original Medicare legislation, attached to President Johnson’s Medicare Bill, As Enacted.  It is also fair to say that in the poorer states, such as Louisiana, the state “match” (in terms of dollars) is but a tiny share of the cost of any type of Medicaid Care delivered in Louisiana: whether in-patient Nursing Home Care, which is funded (the lion’s share) by the Medicaid Program, and thus by the federal government, for the most part.


Louisiana is, however, unlike most states, when discussing medical care for the state’s poor.  Simply put, Louisiana has operated (well before Medicare or Medicaid became law, by the Congress, and the president in 1965) a number of so-called “Welfare Hospitals”, sometimes, called the state’s Charity Hospitals.  These go all the way back to Senator, and before that, Governor Huey Long, the populist Louisiana governor and potential Democratic presidential candidate, this before his assassination in 1933.  However, since Hurricane Katrina literally wiped some of these buildings off the face of the earth, or rendered them incapable of restoration, this acute care system of charity care has floundered.  In its place, moreso than in earlier years, but now, Louisiana uses its Medicaid Program to care for these poor and sometimes totally indigent patients, this via community and/or State Teaching Hospitals near these critical care patients.  Thus, even though the vestiges of this Huey Long-era acute care hospital system is to be commended, and indeed, does distinguish Louisiana from most other states, there never were, under the 1930’s State Charity Health Care operating in Louisiana, sufficient long-term care facilities.  In fact, virtually none existed, except very expensive private and/or religious facilities offering such care, i.e., sub-acute medical care, of a residential nature, NOT requiring acute, hospital-based stays: working in tandem with such facilities.


Thus, Governor Romney’s cavalier suggestion  …..that “states can do what they are doing best, themselves, and at the local level”, is nothing short of ludicrous: unless he was proposing to have the Congress, starting with the U.S. House of Representatives, EXPAND funding for such sweeping, and comprehensive care of this country’s medical poor.  Both Democratic, as well as Republican congresses have known this for years: and although Romney presided over, ran the state government of one of the most wealthy states in the union, even he knows that no state (not a single one) is now prepared, capable of stepping up and caring for all but a precious few, who need, and now enjoy, what are mostly federally funded sub-acute care (Nursing Home) services, again, under Title XIX of the federal Social Security Act.  And while Medicaid Waiver Programs make more and more sense, especially with the onslaught of the Baby-Boomer population in need of long-term care, each year out, states such as Louisiana operate with threadbare budgets, totally incapable of providing any medical or nursing services for these, soon to be, millions of newly frail elderly.  Any suggestion that states can “do this best” (and alone) would be to relegate our family and friends to the once, “Poor Houses” more apt to a Dickens novel, than any bite of reality in the current day: all of which makes Governor Romney’s “tossed remarks” from any debate stage, the ultimate absurdity, as every state, as well as federal legislator knows, for certain.  Now, here come the NEW CROP of candidates for president.  It certainly remains to be seen (AND NOW) what, IF ANYTHING, the GOP will do, should the U.S. Supreme Court soon rule the Affordable Care Act (“Obama Care”) illegal, as drafted by the Congress.


NEXT ISSUE:  “A Look At Achieving Release From A SKILLED Nursing Home Bed” : AND….a return to the home of a nearby daughter: …with medical care/needs provided through the Medicaid Waiver Program ….and a life WELL-LIVED, until the end, NOT EVER again in any Nursing Home !!


*** BULLETIN: ****** BULLETIN: ***:  By the time you are reading this, you now know that the U.S. Supreme Court ruled in June 2015, by a vote of 6 – 3,  that the Affordable Care Act (OBAMACARE) was, and is, 100% legal, and in every way, comports with the U.S. Constitution.



Copyright (2015):

A.D. Buford, III, Esq.

July, 2015

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