Caring for Grandma on the I-80 Corridor

Republican “reforms” of Medicaid, which seem to be composed of stalling funding until the program can be gutted in 2025, could easily have a negative impact on those families trying to find skilled nursing care for elderly relatives along the I-80 corridor in northern Nevada.  As noted in the previous post, health care facilities in northern Nevada have service areas of miles and miles of miles and miles.  The euphemistic term “remote rural” is especially pertinent in this instance.  These may be the “cow counties” but they do include a significant number of individuals over the age of 65.

By The Numbers 

Pershing County (Lovelock) has a total population of 6,560 of which 14.8% are over 65, and 11.1% of those are disabled individuals under the age of 65.  Humboldt County (Winnemucca) population of 16,842 includes 11.9% over 65 and 8.3% under 65 disabled. Lander County (Battle Mountain) has 5,702 people, of whom 13% are over 65 and 6.5% are disabled.  Eureka County (Eureka) is a small entity with 1,917 people of whom 12.9% are over 65, and 6.6% are disabled.  More populous Elko County (Elko) with 52,168 people has an over 65 population of 10.0% and 8.4% disabled individuals.  Churchill County (Fallon) has a population of 24,198 of whom 18.7% are over 65 and 6.5% are disabled.

For the sake of this analysis, let’s assume that the families would like to find skilled nursing facilities for their elderly relatives closer to home than securing similar residences in the Reno/Sparks/Carson City area.  That means finding skilled nursing facilities in the towns listed above.  Elko County has such a unit with room for 110 residents, Fallon has a facility with a capacity for 74 residents.  Lander and Eureka counties are served by a facility in Battle Mountain with a capacity of 18.  Pershing county has one facility with a capacity of 25 residents, and Winnemucca has a skilled nursing facility for up to 26 residents. [Links]  We’re speaking in numbers at present, but it’s important to remember that those numbers are specifically associated with real people, and very real families who are seeking affordable quality care for those individuals.

The cost of skilled nursing care will vary with the level and type of medical or rehabilitative services required, however we can generally assume that the monthly price tag for SNF care in Nevada is about $8,213.  Drilling down a bit deeper, the reported minimum cost per month for Skilled Nursing Care in a semi-private room is about $3,346; the median is $7,128; the maximum is $8,425.  Private rooms come at a minimum of $4,106, a median cost of $8,213, and a maximum cost of $15,452.  [SNF]  At this point another reminder is appropriate — these aren’t price tags, the numbers represent what a family might have to pay for care specific to the needs of their elderly relatives.

And now we return to the numbers.  In the State of Nevada 1 out of every 7 persons over the age of 65 is covered by Medicaid. Medicaid covers 3 out of every 5 nursing home residents. [KFF]  Consider for just a moment what would happen to the fiscal solvency of the residential facilities listed above in the rural counties if Medicaid is cut, then “reformed” into block grants (which can be further cut by Congressional action) and finally all but reformed out of existence by Republican representatives.

Mythology

Let’s work on some of the elements of Republican mythology commonly associated with their efforts to slash the Medicaid program.

(1) It was only originally intended to cover the “really poor.” Republicans have an interesting way of defining “poverty.”  Several reports of recent memory decry the fact that people on various welfare programs have CARS (to get to work) and REFRIGERATORS (which come with most furnished apartments.)  Left to their own devices it’s easy to imagine that unless a person is naked, living rough in the bush, and starved into semi-consciousness the individual wouldn’t qualify as “poor” by some Republican standards.  That said, Medicaid isn’t really a welfare program — it’s essentially a health insurance program.  One way to extend this health insurance coverage was to apply income eligibility standards for publicly subsidized health insurance — for the low income families, for the aged and for the disabled.

(2) The states can do better because they are closer to the problems.   There’s a reason we have a federal system — there are some tasks which the states are not capable of adequately addressing.  Providing health insurance coverage for millions of Americans working at low wage jobs, who have disabled family members, who have aging family members, and have children in need of health care services is one of those objectives best addressed by federal resources.  Imagine if someone said the states can best determine what security is best for them?  Should we block grant the Defense Department budget, send it to the states and let them decide how to fund the elements of their National Guard?  This sounds ridiculous, and doesn’t the Constitution require government prioritization of our mutual defense? Yes, and it also provides that our government provide for our “general welfare.”

(3) We’re really not cutting anything.  No? When the inflation rate for the medical sector exceeds that of the other sectors of the economy, and budgeting or funding proposals don’t meet or exceed that inflation rate the end result is a cut.  It’s not mathematics, it’s just old fashioned arithmetic.  There’s also something disingenuous about continually clamoring for tax cuts (especially at the state level) and then offering that the states should pick up more of “their share” of program expenses.  Finally, it’s always easier to cut funds from “block grants” than it is from specific program budgets.  Yes, the Republicans intend to cut Medicaid; if it’s done slowly or quickly is beside the point — at some date the result will be the same.   Program cuts will affect those real people in those real skilled nursing facilities, both the staff providing the services and the residents who depend on them.

Senator Dean Heller should be aware of these issues, and if he isn’t perhaps he should receive some phone calls this week.  702-388-6605;  775-686-5770; 202-224-6244.

*And we still haven’t discussed the benefits of Medicaid supported home health care programs!

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