CHARGES AND EXTRAS
Nursing homes usually quote prices as a daily
rate for a semiprivate room. But that number is just the base. Typically,
facilities charge separately (and exorbitantly) for supplies such as diapers,
catheter tubes and rubber gloves, as well as for special services like
incontinence care, pressure-sore treatment, hand or tube feeding, even
turning and positioning. Doing a resident's laundry often generates a separate
charge.
CR's table shows how extra charges can boost
the cost of a month's care. It lists for each FACILITY (located in two
adjoining Maryland counties), the private-pay monthly charge (PRIV), incontinence
care (INCONT), bedsore care (SORE), laundry (LAUN), hand-feeding (HAND),
turning and positioning (TURN), the total of EXTRA charges, and the grand
TOTAL. If a facility gives a range of rates for semiprivate rooms, we use
the lowest daily rate. Dashes mean the facility charges one inclusive price
for each level of care. (Levels reflect how much help residents need with
medications and activities of daily living.)
|
|
FACILITY |
PRIV |
INCONT |
SORE |
LAUN |
HAND |
TURN |
TOTAL |
| Fairland Adventist |
$3000 |
$180 |
$368 |
$53 |
$105 |
$165 |
$187 |
$3871 |
| Kensington Gardens |
3150 |
150 |
90 |
50 |
60 |
0 |
350 |
3500 |
| MedBridge |
360 |
158 |
87 |
56 |
150 |
103 |
554 |
3914 |
Lorien Nursing
& Rehab. |
3480 |
90 |
0 |
40 |
0 |
0 |
130 |
3610 |
| Bon Secours |
3690 |
120 |
0 |
66 |
0 |
0 |
186 |
3876 |
Shady Grove
Adventist |
3900 |
224 |
368 |
53 |
165 |
165 |
975 |
4875 |
| Hebrew Home of G. Wa level 1 |
4500 |
0 |
0 |
0 |
0 |
0 |
0 |
4500 |
| Hebrew Home of G. Wa level 2 |
5250 |
0 |
0 |
0 |
0 |
0 |
0 |
5250 |
| Hebrew Home of G. Wa level 3 |
5550 |
0 |
0 |
0 |
0 |
0 |
0 |
5550 |
The daily rate gives no clue to the total cost
when a facility loads on the extras. The total for the ancillary services
ranges from $130 to more than $900. The two highest daily rates at the
Maryland facilities that added extra charges are at Bon Secours and Shady
Grove Adventist. But Bon Secours had one of the lowest totals of extra
charges and Shady Grove the highest. (Note that the Hebrew Home of Greater
Washington charges an all-inclusive rate. Homes with all-inclusive rates
may be more or less expensive than facilities that charge separately for
services.)
Physical, occupational and speech therapy cost
extra too. Prices are usually quoted as price per unit of treatment, which
often lasts 15 minutes. The Beverly Manor Convalescent Hospital, in San
Francisco, told CR it charged $54 for 15 minutes of speech therapy, $54
for occupational therapy and $38 for physical therapy. At those prices,
it's not hard to see how therapy is beyond the means of most families who
must pay on their own. Even if you find cheaper therapy services, a facility
might not allow you to bring a therapist into the nursing home.
The U.S. General Accounting Office (GAO) thinks
those speech, occupational and physical therapy may be too expensive for
Medicare. A recently released GAO report noted "widespread examples
of overcharges to Medicare for therapy services" delivered by rehabilitation
companies and nursing homes, and concluded that "extraordinary markups"
for services result when providers exploit ambiguities in the regulatory
system and weaknesses in Medicare payment rules. The GAO found that therapists'
salaries ranged from about $12 to $25 an hour, but some billed Medicare
$600 an hour.
Prescription drugs are another profit center
at nursing homes. Drugs and other supplies residents need carry high markups,
and families are often captives of the nursing homes and pharmaceutical
outlets connected to them. Beverly Enterprises, for instance, owns Pharmacy
Corporation of America. Nursing facilities may require you to use their
drug suppliers or at least make it difficult to use others that may be
cheaper.
CR sought prices for three common prescriptions
taken by older people from the pharmacies supplying five nursing facilities.
One refused to quote prices, and the others were suspicious of our query
and provided questionable information, making it impossible to compare
their prices with those from local pharmacies or from mail-order sources.
But the family of a resident at a Beverly Enterprises facility in Los Gatos,
California, matched the prices charged by the nursing home's pharmacy against
prices for the same drugs at their HMO's pharmacy.
Cephalexin, an antibiotic, cost $30.20 at the
HMO, $100.10 at the nursing home. Digoxin, a heart medication, cost $23.80
at the HMO, $47.28 at the nursing home. Lotrimin, an antifungal cream,
cost $11.70 at the HMO, $32.23 at the nursing home. The resident also needed
drain sponges. The nursing home charged $2.49 per sponge. They cost 46
cents each when bought at a local pharmacy in a box of 50.
Don't allow price gouging. If you can't get
pharmaceutical prices from a nursing home beforehand, track them as they're
billed. If you learn, as the California family did, that the resident is
being charged double or triple the price at other pharmacies, demand the
right to buy drugs outside the nursing home.
BLOCK GRANTS TO STATES
If Congressional leaders have their way, the
federal government will turn over billions of dollars to the states and
let them figure out how to provide basic health care for the poor and long-term
care for the elderly. Block grants for Medicaid are ostensibly designed
to shrink a portion of the federal budget and turn decision-making over
to local politicians "closer to the problem." CR thinks block
grants are likely to make a bad situation worse for women and children
as well as for the elderly who need nursing care.
People who depend on Medicaid are already last
in line for a nursing-home bed, behind those who qualify for Medicare reimbursement
or who can pay privately through some combination of insurance coverage
and personal wealth. That's because Medicaid pays less than Medicare and
less than what the private market will bear. Under block grants, states
would get less federal money and may not be required to match federal dollars
with their own dollars, as they do now. Some states might continue to fund
the program generously, but others might not.
The combination of fewer dollars, inflation
and growth in the number of elderly people needing nursing-home care is
certain to squeeze Medicaid. The result is predictable: o States will reduce
benefits and make it more difficult to qualify for them, throwing the burden
onto the family. o Fewer people will be covered. Those who are will find
it harder to compete for space with Medicare patients and private-pay patients.
o Many nursing homes will reduce the quality of care further in the face
of shrinking reimbursement.
Many state governors like the idea of block
grants. Not only would block grants allow them to invest fewer dollars
of their own in the Medicaid program, but they could also avoid meeting
federal standards--the much-despised "mandates." "Federal
mandates present little state flexibility and hinder state attempts to
be part of the 'mainstream' approach to health care delivery," said
John Rodriguez, California's deputy director for medical care services,
in recent testimony before a House subcommittee.
Among the mandates that state government's
find "troublesome" are rules that require a state to set a minimum
amount of income a husband or wife can retain to live on after most of
the family's liquid assets and most of its income have been spent on nursing-
home care. Block grants could spell the end of rules that keep spouses
from becoming impoverished when their partners enter a nursing home.
Another mandate is the rule requiring that
nursing homes pay a "reasonable and adequate" fee. These provisions
annoy states because nursing-home owners have won a number of lawsuits
forcing states to increase reimbursement rates. If states allow Medicaid
reimbursement to sink too low, nursing homes will either turn away Medicaid
residents or allow the quality of care, already none too high, to deteriorate
more. States also complain that they now have to pay the Medicare premiums,
deductibles, and coinsurance for elderly people with incomes below the
federal poverty level, even though nearly 60% of those eligible fail to
apply.
States object to the mandate that standards
be set for the quality of care in nursing homes. The nursing-home reform
law passed in 1987 requires facilities, among other things, to assess new
residents and devise care plans that help them achieve some quality to
their lives. It limits the use of restraints. Although the law hasn't done
a perfect job (enforcement penalties just took effect in July) life without
standards will no doubt be worse than life with standards.
CONSUMER REPORTS RECOMMENDATIONS
A stay in the wrong nursing home can be a physical
and emotional catastrophe. While you should be able to locate one of the
right nursing homes with the help of the Ratings in CR's report on how
to choose a nursing homes, that's only half the problem. With the cost
of nursing-home care now anywhere from $2,000 to $6,000 a month, and with
stays possibly lasting many months or even years, consumers need a plan
to avoid financial calamity. Here are things to consider, whether planning
for your own future or helping a parent make plans.
Don't depend on Medicare alone. Medicare pays
nursing-home benefits only if the stay is required by an illness or injury
that put you in the hospital first. And Medicare pays for no more than
100 days in any benefit period. (A benefit period ends when a person has
not been an inpatient of a hospital or a skilled- nursing facility for
60 consecutive days.) One hundred days is a brief period, as nursing-home
stays go.
Avoid nursing homes not certified for Medicaid
residents. Even though you or your parents may never have been poor, a
nursing- home stay often leads to impoverishment. At that point, Medicaid
may be your family's only option.
Consider buying long-term-care insurance. Do
so at age 65 or younger if you are unwilling to see assets accumulated
over a lifetime depleted by a nursing-home stay. Such insurance may make
it possible to stay in a nursing home as a private-pay resident if you
are not eligible for Medicare benefits, or if those benefits have run out.
The only other way to protect what you have
accumulated is to give it away, that is, to impoverish yourself and make
yourself eligible for Medicaid before a nursing home stay impoverishes
you. To do that in a way that avoids triggering gift taxes may require
the help of an attorney experienced in trust and estate law. In any case,
the help of a lawyer familiar with Medicaid rules may be invaluable as
you begin to help a parent or yourself.
WHERE TO FIND HELP
Families without wealth or insurance may face
cruel problems finding a good nursing home for an infirm loved one. One
place they might turn for help is a private advocacy group. Nonprofit organizations
that try to champion the interests of nursing-home residents are
active in a number of states. They monitor conditions in nursing homes,
provide advice to families seeking assistance and help resolve complaints.
A few of those groups also supply written materials on choosing nursing
homes and, in some cases, offer specific information about the care provided
in facilities.
Reports are published by a few state advocacy
groups: o The California Advocates for Nursing Home Reform publishes a
report that lists the citations and fines levied against nursing homes
by the California Department of Health Services. o Citizens for Better
Care in Detroit produces a large volume of summaries of state inspection
reports ($10). o Friends and Relatives of Institutionalized Aged in New
York City publishes a consumer's guide that lists nursing homes and adult
homes, and gives other information regarding long-term care.
The National Citizens' Coalition for Nursing
Home Reform, a consumer group that lobbies for improvements and better
care for nursing-home residents, has identified the following active groups
that might be helpful. You may also want to contact the Coalition, for
other resources.
NATIONAL CITIZENS' COALITION FOR NURSING HOME
REFORM--
Elma Holder, Executive Director, 1424 16th St. N.W.
Suite 202, Washington D.C. 20036-2211. 202-332-2275,
Fax: 202-332-2949.
CALIFORNIA--Pat McGinnis, Executive Director,
California Advocates for Nursing Home Reform,
1610 Bush St., San Francisco, CA 94109. 415-474-5171,
Fax: 415-474-2904.
FLORIDA--Fran Sutcliffe, Nursing Home Hotline Patrol,
6429 Gulfport Blvd. South, St. Petersburg, FL 33707-3000.
813-347-0953.
INDIANA--Paul Severance, Executive Director,
United Senior Action, 1211 South Hiatt St.,
Indianapolis, IN 46221. 317-634-0872,
Fax: 317-687-3661.
KANSAS--Margaret Farley, Executive Director,
Suite 202, Lawrence, KS 66044. 913-842-3088,
Fax: 913-832-2813.
LOUISIANA--Alan Pincus, Citizens for Quality Nursing Home
Care, P.O. Box 56041, New Orleans, LA 70156. 504-523-2055,
Fax: 504-586-1627.
MASSACHUSETTS, Abigail Bottome, Executive Director,
Living Is For The Elderly, 27 Maple St.,
Arlington, MA 02174. 617-646-1000, ext. 4733,
Fax: 617-646-1000, ext. 4735.
MICHIGAN--Susan Titus, Executive Director,
Citizens for Better Care, 2111 Woodward Ave., Suite 610,
Detroit, MI 48201. 313-962-5968, Fax: 313-962-5340.
NEW YORK--Geoff Lieberman, Executive Director,
Coalition for Institutionalized Aged and Disabled,
Brookdale Center on Aging, 425 E. 25th St., Room 818,
New York, NY 10010. 212 481-4348, Fax: 212-481-5069.
Jean Murphy, Executive Director,
Friends and Relatives of Institutionalized Aged,
11 John St., Suite 601, New York, NY 10038. 212-732-4455,
Fax: 212-732-6945.
Cynthia Rudder, Director, Nursing Home Community Coalition
of New York State, 11 John St., Suite 601, New York, NY
10038. 212-385-0355, Fax: 212-732-6945.
NORTH CAROLINA--Marlene Chasson, Executive Director,
Friends of Residents in Long Term Care, 3301 Womans Club
Drive. Suite 10, Raleigh, NC 27612. 919-782-1530 (no fax).
PENNSYLVANIA--Diane Menio, Executive Director, CARIE,
1315 Walnut St., #1000, Philadelphia, PA 19107.
215-545-5728, Fax: 215-545-5372.
TEXAS--Lou O'Reilly, President, Texas Advocates for
Nursing Home Residents, P.O. Box 763143, Dallas, TX 75376.
214-371-6330, Fax: 214-371-6330.
Marie Wisdom, Advocates for Nursing Home
Reform, 16908 S. Ridge Lane, Austin, TX 78734-1235.
512-266-1961, Fax: 512-266-1961.
VIRGINIA--Joani Latimer, President, Richmond Friends and
Relatives, 1426 Claremont Ave., Richmond, VA 23227.
804-264-2730, Fax: 804-355-1541.
WISCONSIN--Robert Snow, President, Citizen Advocates for
Nursing Home Residents, 4565 N. 126th St., P.O. Box 104,
Butler, WI 53007-0104. 414-783-7161, Fax: 414-781-6565.
Copyright Consumers Union of U.S., Inc., September
1995.
We welcome reciprocal links and/or banner exchanges
with sites of similar content and interest. Submit Here
(800) 
574-8840
©
1997 
ken@ltcfs.com
235 S.W. 33rd St
Cape Coral Fl 33914
