I still remember the power a simple Hershey’s milk chocolate bar had on my grandmother in the months before she died.

This simplest of luxuries delivered to her nursing home room was sure to garner a goofy grin and a childlike, “Oh, goody goody!” Every single time, without fail.

My mother or I would peel the label back for her, her shaky, thin-skinned hands no longer able to do so. She’d nibble on a piece or two while we visited, relishing it in a way I’ve never been able to appreciate.

When we’d leave, the rest of that full-size bar would go into a plastic container she could more easily open on her own. She’d savor it a few bites at a time until our next trip in.

Barely out of college at the time, I had no idea why that cheap candy was so precious to her. 

Today, knowing the incredibly tight dollar amounts that institutionalized Medicaid beneficiaries live by, I have a new perspective on her desire to make little luxuries last.

The monthly amount that Medicaid allots residents for a personal needs allowance varies by state: $30 is the lowest, $200 the highest and $60 the national average. And the federal government hasn’t done anything to increase the range since 1987. 

While we delivered Grandma Audrey occasional new clothes and snacks over her long-term stay, her ability to buy new things for herself was truly limited. When she failed to communicate that she needed something — or later, couldn’t communicate — we might show up empty handed. Were her allowance gone for the month, she’d have to wait for our next visit to get restocked, to use the lilac bar soap she loved, or replace the socks that always seemed to go missing.

Even today, 15 years later, residents in her native Maryland get just $75 monthly. That doesn’t get anyone anywhere very far these days, and maybe even less so in the Washington, DC, suburbs.

In recent weeks, patient advocates in several states have called for an increase in monthly allowances. I’d like to see nursing home operators add their voice to that chorus.

Providers are operating on razor-thin, often negative margins. Yes, raising residents’ allowance would require states to dole out money that providers themselves would like to tap into to cover their own increased costs. But there’s a greater good in promoting a program that delivers residents personal choice, dignity and tiny moments of happiness, one bottle of pop or one pip of chocolate at a time.

Patients don’t necessarily make a distinction between the various programs or funding streams that pay for what they need. But many know they have no real spending money, their social security and other limited income rerouted to cover the government’s cost of caring for them. 

Residents do know, however, when something improves their quality of life. They feel it in a higher quality brief, taste it in a favorite snack or hear it over their in-room phone — all of those items that residents might pay for out of their allowance. 

And it’s those little, sometimes unaffordable things that can make a nursing home feel a little bit more like a true home should feel.

Kimberly Marselas is senior editor for McKnight’s Long-Term Care News.

Opinions expressed in McKnight’s Long-Term Care News are not necessarily those of McKnight’s.