We probably haven't met. Mostly, I meet really sick elderly people when they come to my hospital. Not for tea, but for high quality inpatient medical care. You being an average person and all, we likely haven't had the pleasure of the 7am exam in which I poke and prod you and then ask you weird personal questions. ("Why the hell does she care so much about my poop?" "I do, average person. I care... regretfully for me and somewhat embarrassingly for you. But it's my job.") since we haven't met before, I thought I'd write you this letter about a topic that is important to both of us.
It would seem that many people don't understand Medicaid. You may well be one of them. And even if you are not, please humor me. I promise that it will be worth it. Grab a beverage and put your feet up. This will be long. Long but so very important to Y.O.U.
Many people think that Medicaid is only for poor people who are not working. And yes, it does cover some people in that category. As Conway recently said, they can just get a job. Amiright? Slackers. Damn toddlers and 98 year olds should be working for their medical insurance. Wait, what?! Yeah, Ms Conway <shockingly> got that statistic wrong. As did you.
Did you know that Medicaid pays for about 50% of nursing home stays? Did you know that if your elderly relative breaks her hip or has a stroke etc, that Medicaid is the insurance that will be used 50% of the time to pay for their stay in a nursing home for rehab?
This is one reason that the senate's healthcare bill is so destructive. Cuts to Medicaid (making it per capita and ending the expansion) will greatly impact the elderly in nursing homes. And it will impact YOU!
Let's get real here. A lot of people think that they have no skin in this game. They have employer based insurance and live a healthy lifestyle. They are young enough with no bad health issues. They make a comfortable salary. So let's forget about helping less fortunate people. Forget helping sick kids. Forget helping the elderly. Forget helping the disabled. I get it. You think that you won't be affected by this bill.
But you are wrong.
Do you have a parent? Do you have a grandparent? An elderly aunt or uncle? As a doctor, I can tell you that old people fall and break bones. Old people have strokes. Old people have heart attacks. Old people get dementia and are too confused to take care of themselves. Heck, old people get colds and end up in the hospital, weak and infirm. And after their hospital stay in which those issues were patched up, cared for by yours truly, those elderly patients (your relatives) are ready for discharge. Where to? Well, if it was a serious malady, usually not home. They can't care for themselves. They are too weak. They need a month or more of rehab to regain that ability. Sadly, sometimes they never do.
That rehab usually takes place at a skilled nursing facility. These magical places are usually covered in part by Medicare and supplementary private insurance. But at an average of $10,000 a month or more, those benefits quickly run out. And then your loved one will quickly blow through their savings. And that's where Medicaid comes in. Medicaid ends up paying for about 50% of nursing home costs. It is a major factor in the care of elderly people in nursing homes.
The senate, in their infinite wisdom, has seen fit to make drastic cuts to Medicaid. Meaning that those benefits will not be there for your Nana or Mom or Great Aunt Cecelia when they fall and break a hip. What does that mean?
It means that your elderly relative will have to pay out of pocket for nursing home care. That's $10,000 a month. Does your Dad have that in his savings? Guess who the nursing home is going to come to for payment? Y.O.U. Do you have an extra $10,000 a month to pay for your Dad's nursing home? No? Well then, he's going to be discharged home. He can't care for himself, so that means he is going to be discharged home to your spare room! And since he can't care for himself, you're going to have to do the caring. You know, the stuff a nursing home has 24 hour specialty trained staff to do with expensive equipment like hydraulic patient lifts. Not to mention the rehab therapy that your dad needs to regain his ability to care for himself. Are you going to do physical therapy with him? How about feeding him after the stroke? How about bathing and cleaning him? How about moving him every hour so he doesn't develop bed sores? And during all of that, when are you going to work? Forget home care, because that's also covered under Medicaid. And private duty nursing is oh so expensive.
Are you starting to hyperventilate yet?
But, you say, I just won't take dear old Aunt Martha home from the hospital. If I don't take her home, she's not my responsibility. They can't toss her out on the street, right? Right?!?! Well, probably not. Sometimes we do. But often we don't, because it's a safety issue. So you have chosen to abandon your elderly parent in a hospital. Beyond the fact that that is just morally reprehensible and I will be calling dcf on your ass, let's examine how that can also impact you.
So a bunch of people get wise to the fact that they can dingdongditch their sick elderly relatives. That means that the hospital is left holding the short straw: Uncle Marty. Uncle Marty had a stroke. He can't feed himself, much less walk or care for himself. His Medicaid benefit was capped by the senate, so he can't go to a nursing home for rehab. His family abandoned him. He does not have the tens of thousands in his bank account to pay for nursing home care. So for the next two months, Uncle Marty gets to sit on my patient list. I grow to call him one of my permanent residents. He starts getting mail delivered to the hospital. The nurses all know him by name. He gets a full two months of therapy until he is finally able to care for himself and be discharged home (sweet jeebus, don't let me get stuck with that discharge summary). The problem is that for the past two months, dear old uncle Marty has been sitting in a hospital bed for no reason. He is well enough to be discharged, but he needs rehab. So that means one less patient could be admitted to the hospital for two months.
But remember, it's not just Uncle Marty who had a stroke. There's Aunt Bedelia with her broken hip. There's Gramma Hortence with her pneumonia and resultant debility. There's Grandad Glenn with his heart bypass. The list goes on. And for the time that they need rehab, they will be taking up hospital beds. And before long, especially in Florida where our state bird has blue hair and enjoys the early dinner special, hospitals quickly fill to capacity with people who don't need to be in the hospital. Hospitals become the new nursing homes.
But what, dear young reader living a healthy lifestyle, does that matter to you? Well, when hospitals are full, wait times go up. Car accident? Appendicitis? Migraine headache? Back strain from helping your buddy move last week? Uti on the weekend? Your er wait time just went from 3 hours to 12 hours. Need to be admitted for emergency surgery for your appendicitis? Too bad, so sad. Thank a senator. This hospital is full of nursing home patients.
You have skin in this fight. You may not think you do, but you are wrong. Everyone has skin in this fight. Even the young. Even the healthy. Even the people with great employer based healthcare plans. Even the wealthiest among us. And yes, even your senator and Ms Conway. This bill will impact us all.
So call your senator. Tell your senator to vote no on the senate healthcare act. Senate switchboard: (202)224-3121
If you won't do it for the disadvantaged, the disabled, the children, the elderly, the pregnant women, the people with organ transplants, do it for yourself. Illness will come for us all eventually. Don't you want affordable easy to access healthcare when it does?
Signed,
Your Friendly Local Bitter Hospitalist
PS Don't be a dick to your elderly relatives. They took care of you. Now it's time to take care of them. Call them. Visit them. Send them a friggin card and some flowers, dude. They're lonely. They think of you often and have probably told me all about you, complete with showing me photos.
