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Section: Being Well
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Toby Laping
Ph. D., C.S.W.,
Private Care Manager
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Placement for Hard to Place Seniors
By Toby Laping, Ph. D., C.S.W.,
Private Care Manager
In my office we’re finding it increasingly hard to find appropriate institutional housing for people who are functionally independent - that means for instance that they can dress and go to the bathroom on their own but are nevertheless quite impaired in their short term memory, and who don’t have sufficient resources and/or income.
Several adult care facilities have closed in the past few years, and they were places that often were willing to accept memory impaired individuals with limited resources. I think, for example, of United Church Home and Episcopal Church Home in the City of Buffalo.
At this adult level of care, Medicare is not an entitlement that pays for room and board. Instead, Supplemental Social Security Income (SSI) is the entitlement that picks up the cost of housing for eligible people. Traditionally, people would enter the facility and then convert to SSI whenever their assets were used up and assuming their income was low enough. The problem is that SSI provided so little income to the facilities that it became an unworkable financial arrangement. Facilities cannot be expected to offer acceptable levels of care when there is not enough money to pay for that care. SSI rates are quite simply too low to be appealing to adult care facilities.
Supplemental Security Income is a federal program that operates as a very basic safety net. It is operated by the Social Security Administration and was originated decades ago when the old programs of income support for people who were blind, disabled, or aged were abolished. It isn’t a health care program; people on SSI are automatically eligible for Medicaid.
There are still some adult care facilities that will accept people who are on SSI and who can function with reasonable independence, and who can be safely managed. That means that they have sufficient ability to remember where they live, how to get to their room, and how to be essentially independent in their activities of daily living. However, when you add a shade more memory loss to the mix, you’ve complicated the situation. Then, finding a bed is even more difficult.
This is a growing problem. As people live longer, the numbers of people with memory loss increases, and concerns about keeping them safe will proliferate. Of particular concern are those with minimal care levels but who need oversight and are without financial resources to “buy” their way into institutions. As a society, we must find a way to pay for these people. Putting them directly in nursing homes where Medicaid will pay for costs isn’t necessary and would substantially increase the costs of keeping them safe. That makes no sense.
www.wnycaremanager.com
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