The Uncle in the Attic We Don’t Talk About

The recent debates concerning the future of the Affordable Care Act (ACA) or “Obamacare” also included proposals to block-grant Medicaid funds to the states, which could then determine for themselves how to allocate Medicaid dollars.

Most people, though, do not appreciate Medicaid’s role in paying for nursing home care. This is an important issue that does not get the public attention it deserves.

Most people think of Medicaid as just a health program for the “poor.” Them – not us. But the fact is that ever since the Medicaid “spousal impoverishment amendments” of the mid-1980’s, Medicaid is increasingly a middle-class program, at least when it comes to long-term care. If your mom or dad is middle class, trust me, they likely won’t be able to pay for their long term care costs on their own for long.

Two-thirds of residents in nursing homes are on Medicaid. Elder law attorneys will tell you that oftentimes their first task with new clients is to dispel the notion that Medicare will pay for long term care costs in the long term. (Medicare is a social insurance program that is not means-based and which does not pay for long term costs of a nursing home. Medicaid is a means-based program and does pay for long terms costs in a nursing home.)

The block grants some have proposed for Medicaid would significantly change the way long term care is paid for. (There’s even been talk in the past about the possibility of states requiring adult children to help pay for their parents’ long-term care costs. Surprise!)

There’s lots we could and should be talking about when it comes to how we care for our frail elderly, and how we pay for it. We desperately need this debate. What concerns me is we don’t seem to want to talk about it. Nursing home residents have become the “crazy uncles in the attic,” that we prefer not to discuss in polite society. But discuss it we must. There’s been a huge growth in population needing long term care since the 1970’s, as any of us can attest to. But we ain’t seen nothing yet.

About H. Kennard Bennett

Ken Bennett is a partner in the elder law firm of Bennett & McClammer and is Founder & Team Leader at Scout Guardianship Services. He also founded and serves as Executive Director and Senior Counsel to the Center for At-Risk Elders, Inc., a public interest law firm that, among other things, operates the CARE Volunteer Advocates Program, providing guardianship services to low-income, unbefriended, incapacitated adults.

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