Nursing Homes Apply Profit-Over-Patients Principle

Remember the dumping of mental patients? Well, the new trend is nursing homes dumping long-term or difficult patients. This trend is a function of several conditions unique to the nursing home/medical industry. Apparently, when patients come out of a 3 or more day hospital stay into a nursing home, their stay is financed by Medicare or private insurance. Medicare pays the nursing home fairly well, as does private insurance. Fast-forward 6 weeks or 6 months and the landscape has changed. The patient has now exceeded the coverage of Medicare or has used up his insurance coverage and so now must be paid for through Medicaid. Medicaid pays about half of the daily rate that Medicare pays.

There are a lot of ways that nursing homes could address this. And there are lots of better ways that nursing homes (the guilty ones) could deal with this. They could lobby for changes in their States. They could establish special wards for Medicaid patients that generate unusual savings through economies of scale. They could create a mass PR campaign to expose the inequity and heartlessness of this system. But what some of them are doing is finding sneaky, marginally legal ways to oust their burdensome patients.

Their methods are clever. The law prohibits simply dumping the patient on the sidewalk (as does basic humanity), and it also precludes evicting patients except under certain circumstances. But, as i said, they're clever. Since they are allowed to evict patients if they close down (as in, go out of business), they have been known to stage a "closing" by locking up for refurbishment or something else. Once a patient is out, there is no penalty against refusal to readmit. (Well, the courts might not allow it, if only more cases were brought to court).

Another insidious way to exile the elderly pests is to admit them to a hospital for a real or exaggerated illness. Once there, again, readmittance is denied.

Money isn't the only rationale for this deplorable behavior. Patients can become difficult, less cooperative, messier or more care-consuming. That's the nature of aging. None of us is going to escape this problem without dying early. So since you too will one day be a victim, shouldn't you care about this? Ironically, of course the same holds true for nursing home administrators. What principles are at play for those administrators as they make these choices? That's clear: The quest for profit and sometimes, pure laziness.

If you have a parent, an aging friend or are approaching your own geriatric years, this is something to note. Start considering how you will deal with efforts of a nursing home to displace your loved one or yourself. How will you argue for your right to care? Without a government that is more invested in compassion that tax-cuts, and without a change in the health insurance system or the way that nursing homes are compensated, you will likely face this dilemma. It would be useful to consider, from the standpoint of a nursing home that is genuinely committed to the principle of patient care, how they can transcend these conditions. How can a nursing home strategize to be profitable, but also maintain patients who may be a financial losing propositions or who make a massive demand of resources?

Whoever solves this problem will be making a difference for millions of people, including you and me.