Does everyone in a nursing home need to be there?

Posted on: May 3rd, 2016 by Mark R. Friedman

The New York Times today reported that the US Department of Justice will investigate whether the state of South Dakota is unnecessarily moving people into nursing homes.

The government has launched a number of these investigations in recent years, driven by advocates who claim that thousands of Americans with disabilities are unnecessarily living in nursing homes.  According to advocates, many working-age people with less severe disabilities are driven into nursing homes because that’s all that these states’ Medicaid programs will pay for.  Instead, some of these Americans could be living in a less restrictive environment with the right support, which often costs a fraction of what nursing homes cost.

It’s part and parcel of a broader debate on how much the government should pay for institutional care vs. home and community based care services (HCBS), and the answer varies with each state.  In the past, New Jersey had more restrictions on Medicaid paying for long term care in the community.  It was easier to get Medicaid funding for care in a nursing home than in an assisted living facility or at home with aides.  Some people went into nursing homes simply because it was the only care option they could afford; even though nursing homes are generally the most expensive setting, they couldn’t get Medicaid elsewhere.

Fortunately, New Jersey has a number of programs now that can help people who need less robust care stay in their homes, including MLTSS, JACC, PACE, DDD services and more.  There are also fewer restrictions on getting Medicaid to pay for an assisted living facility.

People who need long term care generally prefer to get it in the least restrictive environment possible.  Remaining at home may be the most comfortable setting, while an assisted living facility, group home or other alternative institution may provide a more independent and social lifestyle than a nursing home.  There are a lot of folks with severe medical needs for whom a nursing home is the only setting that can provide appropriate care.  But for people who can get the care they need in a more independent setting, it’s good that our state has some programs in place to help them.

If you’re interested in how Medicaid, disability benefits and other programs can provide care for you or a loved one, call or email FriedmanLaw today.

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