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Although no one wants to go to a nursing home, 72% of us will need long-term care, 48% of us in a nursing home. Many people mistakenly assume that Medicare will cover this (It won’t) or that they can rely on Medicaid.

Medicaid Home Health Care

Medicaid home health care of up to 40 hours per week is available only for people who need skilled nursing or therapy as part of that care. While Congress recently extended this “demonstration project,” there is no certainty that it will be there in the future. Even if it is, there is no certainty that we will not need help after the home health aide leaves – or that we will come off the waiting list “in time”.

Medicaid for Assisted Living Facilities

Every state has, in theory, some Medicaid money for assisted living facilities. The amount is so minuscule that the operative phrase is “in theory.” In practice, those of us who can physically manage in an assisted living facility must rely on our own savings and on long-term care insurance, perhaps supplemented by VA benefits.

Medicaid for Nursing Homes

The reality is that almost half of us will spend time in a nursing home.

In selecting a nursing home, we cannot count on finding a bed in a single room in a “Green House” nursing cottage or a single or shared (“semi-private”) room in a nursing home which is part of the “Eden Alternative.” These 21st-century improvements, with privacy, plants, pets and children may not be near our family or even in our area. They may not have a bed available when we need one. They are few and far between.

In Texas, 3% of nursing homes are private pay only. They pay more and, consequently, may have better-qualified staff and lower turnover. People make places.

It is difficult for nursing homes to turn a profit just housing long-term Medicaid patients. They generally must limit the number of Medicaid beds, supplementing them with private pay and short-term Medicaid beds. This results in fewer choices for someone who needs a Medicaid bed, especially following an emergency hospitalization or rehab.

If we do get a Medicaid-certified bed in a nursing home and then are hospitalized, that bed will almost certainly not be there when we return. We may have to change nursing homes altogether.

Rising costs, rising numbers of seniors, rising federal deficits and rising shortfalls in state and city pension funds and budgets can only be expected to result in stricter Medicaid qualification rules – medical as well as financial.

Children Responsible for Senior’s Care?

Our children may also be held responsible to pay for our care – as is already the case in states such as Pennsylvania. Most people do not realize that one of the reasons families took care of their own in our grandparents’ day was that the law required it. In some states, those laws are still on the books. In Texas, some leading Medicaid administrators would like to see them reinstated.

Relying on Medicaid is putting our future – and possibly that of our children – at risk.



Long-term care and Elder law attorney, Terry Garrett, is a member of the National Academy of Elder Law Attorneys and is active in the Texas and Austin Bar Associations. She graduated with honors from Cornell University. She was on the Dean’s List at Wharton Business School. She earned her J.D. at Columbia Law School, receiving the Parker Award and a Mellon Fellowship.

She assists families of people with special needs, people planning for the retirement years and people administering estates.

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