In a piece that has just come out through the news media, nursing home administrators across the nation are having strong concerns about a looming funding crisis.
Citing the recession, a Medicare rate adjustment that will cut an estimated $16 billion over the next 10 years from nursing home care and flat funding from state governments, administrators are either cutting staff or developing strategies to do so in the near future to make ends meet.
According to the American Healthcare Association, Medicaid payments by states to nursing homes fell short by $12 per patient last year as well. These are difficult times indeed.
Long-term care is a complex challenge. Skilled facilities in New York state last year were charging on the average about $200 a day for the care of each resident. Well, $200 a day is more than one can expect to pay even for an ocean cruise.
Which reminds me of an observation that my aunt (who was then in her late 80s) made a few years ago upon returning from a cruise up the west coast of South America.
She recounted a dinner table discussion that she had with her fellow octogenarian cruisers. One lady had been cruising continuously for almost two years. Others had been on various cruise ships for months at a time.
All would have agreed that this was a better bang for the buck than traditional nursing care.
It's questionable whether any of my aunt's fellow cruisers were sufficiently frail to be eligible for nursing home residency. And let's face it, if cruise ships were burdened with the costly regulatory hoop-jumping that nursing homes are faced with, even Bill Gates might think twice about booking an outside berth with a balcony.
Of course if the ship is at sea and registered to Liberia, there is little chance that Department of Health inspectors will be able to board and seize.
One thing is for sure, it is imperative that we think differently about how to address long-term-care policy in this country for the future. These are the facts:
Most older persons are reluctant to spend the waning years of their lives in a nursing home, and people in my age cohort will not put up with institutional care at all in its present form, in the future.
Our nation cannot sustain funding to meet the escalating costs related to nursing home care.
The skilled nursing infrastructure will not be able to accommodate the huge baby boomer cohort as they age into the need for assisted care.
Because of the rapid increase of care consuming diagnoses such as Alzheimer's, diabetes and obesity, traditional institutional care may not be the most efficacious option in addressing the problem.
Don't misunderstand. There will always be a place for institutional care, even if facilities are broken up into a series of service pods, or even become seaborne to accommodate those who have the means to continue to cruise. Skilled nursing facilities have come a long way over the past half century. Administrators and staff are more sensitive to the residents' right to lead a life of dignity and self-respect, and are more motivated to address quality of life concerns than their predecessors.
There will just be more community-based options for long-term care, which will cost less and be more effective in providing a meaningful existence for this surge of chronically impaired individuals.
The community-based option is not cut-and-dried however. Yes, I'd love to be able to establish adult day-care facilities, expand our limited home-care services, have an open checkbook for respite care and have a "chicken in every pot" home-delivered meals program to accommodate the very real long-term-care need here locally.
The reality is that along with the increased cost for these services, there's another, not so apparent stumbling block that policy-makers are thinking but not talking about. Called the "woodwork effect," there's a strong fear that if more community-based long-term-care services are made available, heretofore self-reliant caregivers might "come out of the woodwork" en masse and flood the system with additional clients.
Being that as much as 85 percent of all care-giving in this country is informal and in a sense, donated by spouses, children and children-in-law, an enriched community-based long-term-care system must be carefully thought out.
Fortunately we're a long way from a wholesale dumping of care recipients onto the system. Our staff members continue to see family members, although desperate for personal time, still reluctant to entrust mom to someone else. Care-giving is a bag of conflicting emotions ranging from guilt, to anger, to resentment, to depression, to a sense of duty, fulfillment, joy and compassion. Many of these caregivers have dug deep to reach their higher selves.
Although government's place in this equation must be to lend a helping hand, our loose-knit array of community services is still woefully inadequate in supporting care-giving families. Agencies that provide community-based services need to have additional funding in order to provide the supportive services that will establish themselves as effective care-giving partners.
This will probably mean that some of the funding heretofore directed toward institutional care will be redirected to community-based service options. As painful as it may be for nursing home operators, long-term care as a concept continues to evolve "¦ and this is a good thing.
Tom Briggs is executive director of the Delaware County Office for the Aging.
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