By Rick Banas of Gardant Management Solutions
With so many of the assisted living and memory care communities Gardant operates able to serve individuals on a Medicaid-waiver, the Special Edition of the AARP Bulletin published last month caught my attention.
The focus of the Special Edition was on COVID-19 and Nursing Homes. A variety of reasons are cited for the impact that COVID has unfortunately had on so many nursing homes around the country. Among them are outdated governmental rules and regulations; inadequate funding; and federal and state officials not making nursing homes a priority for Personal Protection Equipment and testing early on in the crisis.
Federal laws enacted in the 1950s are the reason why nursing homes are likely to have an institutional, hospital-like appearance and why shared rooms are commonplace.
In a report to Congress, the federal government’s Medicare Payment Advisory Commission noted that the amount a nursing home received for a resident on Medicaid was approximately 2.5 times less than amount received for a Medicare resident. The report documented that the average payment to a nursing home for a Medicaid resident covered only 97% of the cost of the care provided.
This presents a significant challenge for nursing homes as the majority of residents are on Medicaid; only a small percentage are covered by Medicare; and not all nursing homes are certified to serve individuals on Medicare. As of 2018, more than 60% of residents in nursing homes were on Medicaid; 10% were on Medicare. The rest either paid privately or some other form of payment was involved.
Another issue of significance raised in the special AARP report is that federal government requires States to pay for nursing home care for individuals on Medicaid. States, however, are not required to pay for Home and Community-Based Services (HCBS) that can provide individuals on Medicaid with an alternative to nursing home care. As a result, moving to a nursing home may be the only available option.
Fortunately, Illinois and Indiana have developed HCBS Medicaid-waiver programs that provide a wonderful cost-effective alternative to a nursing home for individuals who need some help to maintain their independence.
Residents benefit from being able to live in a residential rather than institutional environment and get the personal assistance and help with medications they need.
Private apartments are available. The apartments typically feature a kitchenette; spacious bathroom with shower and grab bars; individually controlled heating and air conditioning; and an emergency alert system. Residents are able to furnish and decorate the apartment to their taste.
Certified staff is on-duty 24 hours a day, seven days a week and can respond to scheduled and unscheduled needs for assistance.
Support services such as three daily meals plus snacks, housekeeping and laundry are included.
Of the nearly 60 senior living, assisted living and memory care communities Gardant operates, more than 50 are approved to serve individuals on a Medicaid-waiver for assisted living. The communities are located throughout Illinois and Indiana. Click here for a list of locations.
Most of the communities are designed to serve older adults. Two of the communities in Illinois can serve individuals 22 to 64 with physical disabilities. Many can serve individuals of all incomes. Some exclusively serve low-income older adults.
Our focus in the communities we operate is to provide residents with the Love, Compassion and Dignity they deserve in addition to the help, assistance, and support services they need. Our goal is to help each resident to achieve and maintain as much independence as possible for as long as possible.
In light of the coronavirus, the safety of residents has been and will continue to be our #1 Priority. We have been and will continue to be highly proactive in taking measures to protect residents and staff. This includes enhanced procedures for cleaning and disinfecting; purchasing Personal Protection Equipment; and adding staff. We have been and will continue to monitor and follow CDC, state and local directives and guidelines. Staff is monitored daily for signs and symptoms of COVID prior to the beginning of their shift and are tested according to individual state requirements. The wearing of masks is required, and other Personal Protection Equipment is on hand and used as needed.
In addition to being of benefit to individuals in need and their families, the communities benefit the federal and state governments as the cost of care for a resident on a Medicaid-waiver for assisted living is much less than the cost of nursing home care.
The programs serve as a model for providing individuals in need of assistance with an appropriate alternative to a nursing home.