Half of America In Poverty and May Soon Be 75%

[bonnie]

Still missing the point, Bonnie. Side by side in the same facility, yes, Medicaid and private pay residents are treated the same. They should not and cannot be treated otherwise.

That your sons manage well run facilities is great. The facilities with which I am associated are well run too. 5 star rating of the nursing homes (ask your sons what that means), among top 10% in quality of care in the state of Maryland, #1 in the county and #6 in the state for our largest nursing home. (I am the chairman of the board...)

Here is the current list of clearly substandard facilities bad enough to be subject to special focus by CMS - http://www.cms.gov/Medicare/Provider-Enr...ads/SFFList.pdf These are what I am talking about. And beyond that there are many more that are ranked below average or much below average that are not on that list now. Many Medicaid seniors end up in these kinds of facilities.

You see, you are still missing the point. There are a significant number of poorly run, substandard facilities, potentially putting seniors at risk of harm. This is not the difference between primo care and basic care. It is falling short of acceptable basic care. Those facilities are not the same as the ones run by your sons, or my team. What I am talking about are the poorly run facilities that for a variety of reasons are substandard. But a significant contributing factor is the substantially reduced reimbursement rate through Medicaid that forces nursing homes to cut costs and cut corners to survive financially. While I cannot say for sure, I would say that most of the facilities on the SFF list are substantially dependent on Medicaid, with a very low percentage of private pay residents, if any. Very few seniors with sufficient financial resources of their own are likely to end up in or stay for long in any of these facilities. And those on Medicaid that do end up there have few options to go elsewhere so are typically stuck there.

That is what I am talking about.

But if you prefer to play the apples to oranges game, carry on... by yourself.

I understand Tom that you are so far above the average person that it is always "you don't understand" or are comparing Apples to Oranges"

Nursing homes are heavily dependent on government payment.Without that they would be hard pressed to stay open

My father was in a very poorly run nursing home on Medicaid.This particular one was in a very expensive area and had a large number of private pay.The care was dismal,private and public pay patients all suffered.

Circumstances beyond our control made it necessary. We did not know how poorly run initially and when we did we moved him back to MN.Small town nursing home,the majority medicaid patients. It was obvious there was not a lot of surplus money for decor,sometimes cracks in the wall and worn carpet.The care could not be equaled. The administrator was responsible for that.

No,I don't need to ask my sons what you mean. They have been responsible for the care of many for many,many years and we speak frequently about their responsibilities and challenges.

In their early years they were administrators of small nursing homes,very dependent on Medicaid. Their starting salaries were surprisingly low for their responsibilities.

Soon both were being recruited to turn around and run poorly run facilities. They did not have any more revenue to work with in the beginning but managed to pull the standard way up.The clientele remained the same.In time as reputation improved,so did revenue.

But joab is right,you think medicaid patients are poorly treated,wait.

Some states do not allow a higher scale for private pay.This has an impact all the way around. Impacting both private and public pay.The less reimbursement that is coming for government pay will force facilities to limit the number of medicaid patients in the future. Not because it is a "welfare patient and they deserve less" but because they cannot absorb the cost.

There are substandard facilities,that has never been denied. But medicaid patients are not denied medical care,decent food etc in favor of private pay.

You can go to a private pay only and get what you can afford to pay for. One of my sons had such a facility.Swimming pools,pool tables,gourmet meals.Good for them,if that is what they want and can pay,Go for it.

The mother of a good friend of mine was placed in a very impressive facility,with a very impressive price tag.

Due to negligence her health deteriorated rapidly due to poor supervision and medical care. She was then placed in the same excellent facility my father was,no fancy building or price tag,but care beyond what you expect.

[Neil D]

What's really strange, Tom, is that you think more government intervention is going to improve things. These institutions are already regulated to death, and for some reason you think more regulation is going to change things.

The government can't run anything efficiently. Look at our government. We're $100 trillion in debt and yet it thinks that throwing more money and more government at the problems it has created is the answer.

The definition of insanity is trying the same things over and over again and expecting different results. Thinking more government is the answer is obviously insane, as that's what gotten us into this situation in the first place.

this argument was used during the Bush years and the Nixon years....and it still compares apples to oranges...

You say it's insanity that is running the government...The difference between insanity and brilliance is knowledge...Remember, it was YOUR REPUBLICAN president put this Democrat president in the bind that WE are in. HE borrowed the money because he had too...And from what this Democrat President was able to do, has saved the auto industry, and made life better for seniors....But the REPUBLICANS, WHOM you want to give control to, has impeded the recovery process and been brutal to OUR recovery...they impeded the recover and thus YOU have your current affairs....We would have been out of this mess if you had told your republican leadership to get to work and pass legislation and to put their hatred of a black President to rest....we are years behind and YOU have no one but yourself to blame....

[Neil D]

Are you referring to care outside a nursing home facility?

Yes,if you have the means you are in a better position.

Ignorant,really.I am well aware that you work in the medical field. I will go with the expert opinion of those that supervise every aspect of nursing home care and the requirements.Both sons are responsible for the handling of millions of dollars a year and they must give a very exacting account,so I do think they know more than you do.

My one son is ultimately responsible for 70,000 employees working in nursing home facilities.Unlike our government officials,the buck stops with him. Medicaid patients in nursing homes do not struggle to receive minimal basic care.

[bonnie]

So what you are saying is that nursing homes should be free of governmental interference, i.e. regulation of any sort?

Do you understand why and how nursing homes are regulated in the first place?

Do you think that taking the government completely out of taking care of senior citizens would improve their lot in life?

In a zero sum game of that sort, no medicare and no medicaid. Only private pay or private long term care insurance (Have you priced that recently?). Where would that leave the 50%+ that this topic started out about?

Here you go again,making up questions to imply that is what was said or meant.

[bonnie]

Either your "expert opinion" is very questionable, or you are not knowledgeable in the terminology of said nursing home care. You are mixing terms....

Quote:

How so? My expert opinion is that of two sons that combined

have spent close to a half a century being responsible for the care of many thousands of elderly residents.Being responsible for million and millions of revenue.Your opinion of them is meaningless.The opinion that means something is the facilities that work very hard to recruit them based on their past performance and knowledge of Medicaid and Medicare.

Keeping complaints to the state for substandard care at zero or a bare minimum

Most facilities are not private pay.They have both. They do not have a medicaid wing/beds and a private pay wing.

When a patient needs rehab they get it. When they need medicine they get it. They get the same meals the private pay next to them gets.It is not announced to the staff that they have a "charity case" coming in.Unless the patient shares with someone that is not common knowledge.

They don't have special beds assigned to medicaid patients.

Depending on the area nursing homes may have a waiting list.

Not ten reserved beds for private pay and one for medicaid. My MIL was private pay and when she decided she felt safer in a facility she had to wait her turn. She lived in senior housing and two of those residents did not have the resources for private pay,they were ahead of her on the list and were taken before her.

No I did not.Perhaps you think so because of "the depth" you are at.

My husband and I are on medicare and supplemental insurance.

He has a respiratory therapist that comes to the house on scheduled visits. Funny how when a change is believed to be needed it is a simple conference with his DR.

This is not medicaid but the pay structure is lower than if it were private pay.

Poor Neil,yes I disagree with you. And yes I do believe my sons and numerous other circumstances over the years before I will take your word.

At the many times you have acted as if you are punishing someone by claiming to be done,I wonder if you comprehend what that word means.

Just for your information I don't believe any nursing home facility notified you they were taking ten private pay in exchange for one medicaid patient. As for seeing this....I've seen where companies will take ONE non-paying patient in exchange for 10 paying one.I don't believe you. That is not knowledge your position as a respiratory therapist would have.

If that should happen to be true then you need to give a little call to the State Board. Staff is not informed of who is and who isn't,nor do they give out information you claim to have without risk of heavy fines

[bonnie]

So what you are saying is that nursing homes should be free of governmental interference, i.e. regulation of any sort?

Do you understand why and how nursing homes are regulated in the first place?

Do you think that taking the government completely out of taking care of senior citizens would improve their lot in life?

In a zero sum game of that sort, no medicare and no medicaid. Only private pay or private long term care insurance (Have you priced that recently?). Where would that leave the 50%+ that this topic started out about?

And the funny thing is as soon as something goes wrong, who do you think will be the first to @#$%& about why the government is allowing that to happen! Sorry people can't have it both ways. The reason that government is in every "tom, dick and harry's" business, is because "tom, dick and harry" have done something that others have complained about, and no else has done anything about it!!

[joeb]

Originally Posted By: bonnie

Are you referring to care outside a nursing home facility?

Yes,if you have the means you are in a better position.

Ignorant,really.I am well aware that you work in the medical field. I will go with the expert opinion of those that supervise every aspect of nursing home care and the requirements.Both sons are responsible for the handling of millions of dollars a year and they must give a very exacting account,so I do think they know more than you do.

My one son is ultimately responsible for 70,000 employees working in nursing home facilities.Unlike our government officials,the buck stops with him. Medicaid patients in nursing homes do not struggle to receive minimal basic care.

Either your "expert opinion" is very questionable, or you are not knowledgeable in the terminology of said nursing home care. You are mixing terms....

Quote:

Never claimed medicare and medicaid are the same.

But you used those concepts as if they were...You are out of your depth here...

Ok, Bonnie,....the only way to silence this discussion is for me to say, You are right...I was wrong....and as always, you have always displayed the superior knowledge....I am done....

Ahh, yes, the "you're too stupid to understand" argument. Seems to me that's called an adhominen attack.