From: stephen@sprunk.org

On 27-Apr-15 16:34, John Levine wrote:
>>> Funny how that doesn't prevent seniors from being on Medicaid to
>>> pay for nursing home care.
>>
>> ITYM Medicare.
>
> In this case, it's Medicaid.  The usual progression is that a sick
> old person spends all of his or her assets on care and becomes
> indigent, at which point Medicaid kicks in and will pay for the
> nursing home. Around here it seems like the majority of people in
> nursing homes (as opposed to fancy places like Kendall) are in that
> position.

Ah, okay; I thought they were mutually exclusive.  It seems like smart
seniors would give all their money to their kids (or put it in a trust
they control) and declare themselves indigent right away rather than
blow all their money on nursing homes and then end up indigent anyway.

Then again, given the horror stories I've heard about nursing homes, I'd
rather put a bullet in my head than suffer such a fate.

> I suppose you could say that's the system working the way it's
> supposed to, but it also seems like better support and funding for
> home care could keep a lot of these people in housing that's a lot
> cheaper than a nursing home.

Indeed.  Medicare ran an experiment where they paid hospitals a flat
amount for caring for chronically ill* seniors; the hospitals sent
nurses out to visit the seniors every month, and the result was a sharp
drop in the rate of hospitalization, better overall health results and
more profit for the hospitals despite lower total spending.

Obamacare contains specific provisions for such innovative approaches,
which previously were only funded as experiments requiring extensive
paperwork and approvals--even if you were just copying a program that
had already been approved (and was working well) elsewhere.

* IIRC, defined as two or more conditions each requiring treatment for
more than twelve months.  There may be other details I've forgotten.

S

--
Stephen Sprunk         "God does not play dice."  --Albert Einstein
CCIE #3723         "God is an inveterate gambler, and He throws the
K5SSS        dice at every possible opportunity." --Stephen Hawking

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