Illinois Seniors Face Tough New Reality
What does Medicaid have to do with Senior Citizens?
Medicaid pays for nursing home costs for most seniors because Medicare only pays for care if you can get well and return home.
Not very long ago, seniors who were fortunate enough to live into old age were cared for in the homes of their children. Life expectancy was shorter, so most people died before they came down with a chronic disease like Alzheimer’s. Now, Americans are living longer and they often out-live their ability to care for themselves. Women especially face major challenges in living with independence and dignity as they age. Women live longer and have higher rates of disability and chronic health problems, but lower incomes than men. Women are the primary providers of long-term care for their husbands and their children. But, when a woman needs long-term care, most likely her husband will have already passed away and often her adult children can’t provide in-home care. Lacking family help, she can’t afford nursing home services. She must rely upon the federal/state program known as Medicaid.
At the time that the Medicaid program was created, very few individuals needed long term care. As a result, our current system provides Medicaid only when someone has a chronic problem and is impoverished enough to meet strict asset and income limitations.
Medicare, on the other hand, covers necessary treatment for a disease for a limited period of time with the goal of returning the individual to a healthy and stable condition. American seniors are provided with such limited period health care coverage by the combination of Medicare, their own optional Medicare supplemental insurance policy, and out-of-pocket payment of any deductible or health care expenses.
Unfortunately for our seniors, the health care support network unravels whenever a physician delivers a diagnosis of Alzheimer’s, Parkinson’s, or other chronic diseases that cause the loss of memory or mobility. Medicare does not provide money for long-term care expenses. (There are some important exceptions for kidney dialysis, hospice, and ALS a/k/a Lou Gehrig’s Disease).
The Medicare payment trigger is the diagnosis of a disease from which the individual will be able to recover or rehabilitate to a healthy and stable condition. Our senior citizens “win the Medicare diagnosis lottery” when they receive a diagnosis of heart disease, diabetes, or another acute care problem. But every day, seniors lose this “diagnosis lottery” when they receive the bad news that they suffer from Alzheimer’s or other dementia, arthritis, Parkinson’s, stroke, or other chronic illnesses.
Medicare will pay half a million dollars to reimburse hospitals and therapeutic staff for the costs of heart bypass surgery. Medicare will pay no dollars for an individual who has a diagnosis of Alzheimer’s or Parkinson’s. Seniors diagnosed with a chronic disease are out of options and out of hope.