When you leave the world of long-term care, you realize how much you know without even knowing it.
My sister, a brilliant lady who lives abroad, recently mentioned to me on a short family vacation that when reading one of my articles she didn’t know what a SNF stood for, or why Medicaid paid so much for long-term care, or how therapy was billed. All of those aspects are parts of our lives we take for granted. A similar sentiment was echoed by a line in a JAMA piece Wednesday written by Andy Slavitt and Gail Wilensky, Ph.D. They wrote, “Many in the United States benefit from Medicaid without knowing it.”
The sentence struck me because I’ve recently heard stories about people who seem to be, for lack of a better word, confused: They have family members whose lives are saved because of Medicaid (or who are in one of your facilities thanks to Medicaid), but support the GOP healthcare plan, or think President Donald Trump will fix the “for-profit” healthcare system. I partially blame both the influence of “fake news” and the constant stream of bad stories coming out of Washington — it’s hard to keep up. Trust me, it feels like we have cycled through about five years of news in the past five months. But in addition to what people are watching and reading, I also blame the healthcare industry a little bit.
That’s because we haven’t found a way to sift through the noise in our conversations. We have been hesitant to talk to our friends or families about what is at stake related to healthcare. We also err in assuming that in one conversation we can change people’s minds. It’s a series of long discussions, ranging from fairly innocuous — what would quality of life mean to you as you aged? — to the slightly more assertive — how do you plan to pay for long-term care? You’d be surprised how many people either assume they are going to die young (these are inevitably the people who will develop diabetes and chronic respiratory problems and live to age 90), or who think the government will figure something out.
It is your responsibility to talk about what you do and to keep trying to have honest discussions. And I also am sympathetic to how fragile family peace can be, and how difficult it can be to rock the boat. All I’m suggesting is to, in the nicest way possible, help people understand how nursing homes are funded.
On a deeper level, there’s also looking inwardly at Wilensky’s and Slavitt’s suggestions. One is to make Medicaid more focused on outcomes. This is obviously a sore subject for long-term care, but should be viewed through the lens of early diagnosis of illness and issues such as low-birth weight infants. Another suggestion is the legitimate concern around increasing primary care access for Medicaid beneficiaries, improving care coordination for dual-eligibles, and allowing states to pursue innovation.
“Medicaid is a highly flexible program, with a variety of different approaches designed to serve the frail elderly, provide substance abuse treatment, create innovative payment approaches, and capitalize on mobile technology,” Wilensky and Slavitt wrote, and highlighted Seema Verma’s letter in March around allowing more state waivers. “Allowing states to move more quickly is laudable, but we must also be sure to have guardrails to ensure that federal tax dollars are being used to improve the health of target populations, that the results of innovations are measured, and that best practices can be spread between states.”
Medicaid matters. And if or when the GOP introduces its healthcare plan Thursday, you should be ready to understand what is at stake.
Follow Elizabeth Newman @TigerELN. Email her at firstname.lastname@example.org.