April 4, 2018
LOCATION: PSD #1 Auditorium (HHI Library not available)
Neil Funnell introduced our speakers:
Bob said he has learned that as people age, many find themselves or their family members in need of care that they have trouble affording. Facing difficult times, they often discover that they know very little about the system they want to access. His work is to help people achieve their goals, and their goals vary widely. Neither Medicare nor Medicaid pays for assisted living. Medicare, which is available to everybody over a certain age, pays for nursing home care and rehabilitation therapy only after at least three nights in a hospital, but restrictions apply. Medicaid is “needs-based” and pays for health care only, but the restrictions are stringent.
“You have to have very little in assets to qualify for Medicaid,” he said. It is legal for anyone with more assets to shed them in some way, such as giving them to future heirs in advance, as long as they do it five years before applying for Medicaid. Otherwise, a process called “asset recovery” can kick in to retrieve assets that were shed. Circumstances, Bob said, may determine the ethicality of such a decision. In some families, adult children need extra financial help. In others, one spouse needs extensive care while the other is healthy. Nursing homes cost about $100,000 a year. In-home care costs about $22 per hour, or about $200,000 a year when the care is round-the-clock.
Some families spend recklessly all of their lives and then expect others (taxpayers) to pay for health care when they need it; their situation may justify that and may not. Others save money carefully and nevertheless find themselves overwhelmed by medical expenses toward the end of their lives and thus unable to leave assets to their children.
So when is Medicaid, which is a program funded by the federal government and state governments but administered by the states, justified?
Susan explained that the states handle Medicaid in widely different ways. In some other states, for example, Medicaid pays for 24-hour care in the home and also pays for assisted living when required. That is not the case in South Carolina. Also, not all nursing homes accept Medicaid patients and sometimes no Medicaid beds are unavailable in desired locations.
She used an anonymous client’s story to illustrate the problem. A single woman who owned her condo and had $80,000 in cash fell and suffered an injury. She needed caregivers four hours a day three days a week. Then she fell again and could no longer use her arms to manage her walker. After selling her condo for $250,000, she went into assisted living for $3,600 a month. Then she fell again and had to move into a $6,000 a month nursing home. Clearly, her assets are not going to last long.
She gave another example of a woman who spent all of her assets on her caring for her husband, and after his death was able to survive only by getting $300 a month from each of her three children.
National Health Care, located on S.C. 170 near Sun City, accepts Medicaid patients only if they have spent at least one year in the facility paying the full price of care, $10,000 a month, and have depleted their assets down to $2,000. Those looking for Medicaid immediately in this area, however, may find they have to go a hundred miles or more away because only three facilities in the county accept Medicaid patients.
Both Bob and Susan cautioned that Medicaid patients in most cases receive less care than those paying privately. Both also said that they see problems for spouses living in their own homes and who are relatively healthy but are spending down assets quickly for spouses requiring extra care.
The audience had many comments and questions:
Our sincere thanks to Bob and Susan for their inciteful, informative, most interesting and well received presentations. Thanks also to Neil Funnell for Moderating and to Fran Bollin for her diligent note taking and excellent summary.