Medicaid Spending Cuts Are A Fate Worse Than Death For Disabled Seniors.

If President Trump were keen on helping our nation’s 46 million senior citizens celebrate Older Americans Month, his proposed 2018 budget is not an auspicious start.

President Trump’s budget will overhaul healthcare by cutting $800 billion dollars from federal Medicaid spending. While states will have flexibility in how to design Medicaid benefits with the limited resources, per-person spending caps are will significantly curtail provision of critical home services for older 4.6 million disabled older adults living in significant poverty.

Medicaid home and community based waiver services provide an in-home alternative to permanent nursing home care. Through this program, older adults receive assistance with bathing, dressing, and in some states, meal delivery services. Yet these services are optional under Medicaid requirements, and likely to be cut or eliminated if Medicaid cuts are enacted.

As a board-certified physical therapist with 7 years of experience specializing in geriatrics, I have worked with hundreds of patients who use these services and are desperate to avoid nursing home care. These patients fear being cut off from the very services that allow them to age with dignity and grace in the comfort of their own homes. These patients fear losing their only hot meal of the day, and perhaps the only social contact they have, when Meals-on-Wheels drops off lunch. And these vulnerable seniors fear having their financial and social autonomy taken from them in a nursing home environment that restricts everything from visiting hours to participation in sexual activity.

The downstream consequences of cutting Medicaid home services to vulnerable older adults are unimaginably sad. Thousands of our nation’s seniors may be forced from their homes and into nursing homes, accompanied by an unimaginable sense of loss for these patients. As these patients enter nursing homes, leaving behind personal possessions and pets, they often wonder “Am I ever going to get out of here?…”

And sadly, the answer is often no. Fears of long-term nursing home admission among older adults are not misplaced. Older adults on Medicaid in nursing homes are likely to die quicker than those living in the community, and frequently experience physical, psychological, or sexual abuse.

Thus, it is not surprising that for many older adults, living in a nursing home is truly a fate worse than death.

A recent study in the Journal of the American Medical Association found that nearly a third of sick older adults believe living in a nursing home is worse than death. Yet, if draconian Medicaid cuts are enacted, thousands of vulnerable older adults could be forced out of their homes and into a nursing home.

Protecting funding for in-home long-term care services allows older adults to avoid nursing home placement. Each additional $1000 spent on in-home care services reduces the risk of nursing home admission by 14%. And healthcare costs are 300% higher for each nursing home resident compared with those living in the community using in-home long term care supports.

Certainly, Medicaid costs must be contained in order for services to be sustainable long-term. But slashing funding is not the only way to cut costs. We can reduce Medicaid spending by incentivizing higher quality care and enhancing coordination between healthcare providers while still maintaining critical services needed for our nation’s vulnerable seniors.

During Older American’s month, we should offer our respect to our nation’s senior citizens by innovative solutions to meet the needs of our elderly citizens, not removing lifelines for those who need our help most. It is our duty to protect the most vulnerable members of our society — disabled older adults living in poverty– by helping them live their remaining years with dignity in the comfort of their homes.

— Jason Falvey is a board-certified geriatric physical therapist and PhD candidate at the University of Colorado Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation.

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