Seniors Feel Pinch of Economy Via Housing
By: Amos Goodall
The economic downturn is not going to affect seniors' needs for help with activities of daily living; people require the same assistance in good times and bad. But it could affect where that help is provided - at home, in assisted living or in a nursing home. And it could affect who provides the care - a family member or someone who is hired.
Here are a few likely trends: Most nursing home care and, increasingly, care at home is covered by Medicaid. This is a joint state-federal health care program for people who are "poor" under its complicated rules. Even before the recession, Medicaid was growing and straining the ability of states to pay the cost. This has caused states to restrict eligibility. These are likely to tighten further.
In Pennsylvania, the Medicaid nursing home benefits program is administered as Medical Assistance. Less expensive to the commonwealth, many seniors recieve in-home assistance under the waiver program of the Department of Aging. If they can, most people would rather remain at home than go to a nursing home, and it is a conundrum that there are different eligibility requirements for these two programs. Due to differing income standards, sometimes folks are almost "forced" into nursing homes.
With fewer people working, more of them will be available to care for family members at home, perhaps delaying or avoiding a senior's move to assisted living or a nursing home. With alternative jobs less plentiful, the supply of qualified care providers should grow.
With money becoming scarcer for just about everyone, families will be less able to pay for nursing home, assisted living or home care. This may result in more beds and services being available and a decrease in costs. In fact, according to the 2008 MetLife Market Survey of Nursing Home & Assisted Living Costs, over the past year, the cost of semiprivate rooms in nursing homes increased just 1.1 percent and the cost of private rooms did not change, in contrast to increases that substantially exceeded the inflation rate in most recent years.
The average rate for a private room is $77,380 a year, or $212 a day, an increase of $1 from last year. The cost of a semiprivate room in a nursing home, which increased 1.1 percent to $191 a day, that is $69,715 a year. The highest rates for a private nursing home room in 2008 were found in Alaska, where the cost is $577 a day on average. The lowest rates were found in the nonmetropolitan and nonsuburban areas of Louisiana, at $127 a day. The cost of assisted living was the highest in southern Maine at $4,708 per month and the lowest in North Dakota at $1,980 per month.
In Pennsylvania, according to the Department of Public Welfare, the cost of a private room is just more than $238 per day or almost $86,830 per year. Meanwhile, assisted living costs increased 2.1 percent from an average of $2,969 monthly or $35,628 annually in 2007 to $3,031 monthly or $36,372 annually in 2008.
We are likely to see bankruptcies of nursing homes and assisted living facilities if they cannot fill their beds as anticipated and if Medicaid and Medicare reimbursement rates are insufficient to cover their expenses. Facility shutdowns will be very disruptive to residents as well as to their families. In testimony before Congress when it was considering the Deficit Reduction Act, representatives of the National Academy of Elder Law Attorneys predicted this result.
Planning ahead is even more important, whether purchasing long-term care insurance, protecting assets to qualify for Medicaid or simply making one's wishes known ahead of time.
Even before to the onset of the recession, many more alternatives to nursing home care were being developed, including assisted living, new home care models, community partnership programs and increased Medicaid coverage of care provided in the community. Anyone providing care for a senior needs to do much more research about the alternatives available.
These changes are not all bad. Fewer Americans working quite as hard as most adults have in recent years should allow more time for us to care for our loved ones and to find the right soultions among the increasing number of care choices available.