As a nursing home administrator (to paraphrase Abraham Lincoln) for two score and six years, one of my many constant concerns are the reimbursement levels to our healthcare organization from the Medicare and Medicaid program for the services we provide.
Medicare and Medicaid certainly are forms of universal healthcare which this nation has experienced for decades. These programs provide medical and therapy coverage (with limits) for seniors 65+ and for the elderly in need of care and housing who are without personal funds and assets.
The success of Medicare and Medicaid (M/M) is in question on many levels. One area in question is the reasonableness of the reimbursements provided to healthcare organizations. Medicaid, in particular, dramatically under covers the actual direct care costs that are required to be provided for by long-term care (nursing home) organizations. Our not-for-profit organization is under reimbursed over $2 million dollars annually from the Medicaid program. This strains every aspect of our operations and has real ramifications on donor requests, employee wages & benefits, staff retention, and our ability to do additional charity work for others in need.
Most leaders in similar organizations and I, join our state and national associations to constantly call on state and national legislators to bring to their attention the financial calamity of M/M.
Now to be fair, they do listen (most of them)! They do feel our pain (most of them)! They do to take action (read: too little, too late)! Year after year, decade after decade . . . we complain. Year after year, decade after decade . . . they respond to nursing homes with occasional small (M/M) reimbursement increases, but certainly not getting near keeping up with direct care costs or even basic inflation, yet year after year, and decade after decade they keep demanding more care, more training, more staffing, and back that up with more regulations and onerous inspections. Year after year, decade after decade nursing homes do more with less, until they reach a point, when they start closing! (More and more common!)
Let me state the obvious! This strategy of complaining to correct a governmental system, that is likely not correctable, is insane! Everyone agrees – a new approach would be welcomed by all.
Say hello to the CLASS Act! The Community Living Assistance Services and Supports Act is a part of the recently passed National Healthcare Reform legislation. The CLASS Act establishes the nation’s first voluntary (though it will be difficult to ‘opt’ out of the CLASS Act) insurance program to purchase long-term care services and supportive care from the community.
[Note to all: CLASS Act is NOT a replacement for Medicare / Medicaid, BUT has the potential to do some ‘easing’ of these ‘stressed to the max’ programs! Also note that the CLASS Act will benefit not only the elderly, but also those younger who have certain disabilities.]
As the so called ‘Silver Tsunami’ or Baby Boom hits the U.S. the CLASS Act takes a new approach to the age old problem of ‘who’ll pay for my healthcare needs when I am old?’ Well the CLASS Act (overly simply stated) requires all working adults to set aside a monthly amount. Lets say for illustration purposes $125/month. This money is put in a private insurance ‘pool’ with government oversight. After paying ‘in’ for a minimum of 5 years (5 years vestiture), the CLASS Act program reimburses (directly to the individual) an amount of $50 to $100/day to cover health care and related community assistance, thus reducing the ‘strain’ of moving directly to Medicare / Medicaid and each individual participating in the CLASS Act.
The CLASS Act is NOT a government entitlement program. It does not use government dollars! It is a government ‘blest’ national private insurance program! It is bold and innovative! It is this kind of thinking that many of us have been encouraging. It was promulgated and promoted by organizations such as AAHSA (American Association of Homes and Service for the Aging) and a variety of national organizations representing the needs of our disabled citizens.
Is CLASS ACT the ultimate solution? NO! It is froth with issues and yet to be tested assumptions! Many might say that $50-$100/day won’t buy a lot of healthcare, but this does substantially address the current problem and it does eliminate some growing strain on the system.
In essence, the CLASS Act is a new national approach allowing for everyone to get Long-Term Healthcare Insurance! Is additional long term care a good idea? Yes! Will insurance companies refine their products to enhance the CLASS Act? Yes!
No matter how, politically, you might feel about the need for ‘change,’ . . . as a health care provider organization, caring for our frail and elderly citizens with chronic health care needs, I believe that years after the CLASS Act is fully enacted – it will represents exciting new options for its participants! The CLASS Act recipients will have the dollars in hand to make their own decisions on who they select to provide for their healthcare needs and hopefully allowing them to get those services while remaining in their own homes. The future is all about allowing our disabled and senior citizens to have choices. The CLASS Act will help them to have the wherewithal to make such choices. This approach . . . a REAL improvement!
Tags: Nursing Home; CLASS Act; Cedar Community BLOG; Medicaid; Medicare