In my prior post, I had mentioned that although New York State’s Medicaid spending per beneficiary on nursing home services was in 2004 35% higher than the average of 38 states that have reported plus the District of Columbia, the actual difference was higher if certain anomalies are excluded. You can see this in the attached spreadsheet, which tabulates data for nursing homes by state and category of recipient. (The Datamart I provided a link to in the prior post allows all kinds of cross-tabulations). For aged beneficiaries, New York State’s nursing home spending for each beneficiary was actually 59% higher than the average of available states in 2004. In the past, when I merely tabulated the aged and (collectively) other nursing recipients, I had believed that New York State’s Medicaid spending per beneficiary on the disabled, such as the mentally retarded and ill, was low. More detailed data show that was a mistake. In reality, New York States spending per beneficiary on the disabled was 49% higher than average. The anomaly is below.
Seniors and the disabled account for most of the Medicaid recipients, and most of the Medicaid spending, for nursing homes throughout the nation. But in New York State there is another big category: “unknown,” as in we don’t know why they are there but they are. Perhaps this is the adult day care category, but I’m not sure. New York State accounts for 25.6% of nursing home beneficiaries and 36.8% of spending among available states in the “unknown” category, and since spending per “unknown” is low, this brings New York’s average down.
One further word about nursing homes. Medicaid pays for health care in nursing homes. People’s Social Security/SSI pays for their room and board. The controversy about Intermediate Care Facilities is this: they are for people who do not require heath care, but want more money than Social Security/SSI affords, so they want additional Medicaid money. Feeding, dressing, bathing, housekeeping, shopping and cooking for seniors who cannot do these things for themselves is not really health care. It is more like caring for a very young child, yet daycare for children is not considered a social obligation here the way it is in, say, Sweden. The issue is a “family of last resort dilemma issue,” as I described it last fall — if you bail out seniors from families that do not provide this care themselves, are you being fair to those that do so at great personal cost while being taxed for the others? In any event, the care of seniors with self-care limitations is going to be a huge problem for our society. Let’s just root for a way to cure or delay of Alzheimer’s.