Who Is Responsible For The Abandoned Medicaid Paitients?

As we gear up to significantly expand the ranks of Medicaid patients under the new healthcare reform law, perhaps we should take a look at some of the issues that have not been resolved under the current program before we make them even bigger. One of the most significant issues is taking care of the debilitated low income Medicaid patients that need rather intensive extended care. Nursing homes reject hundreds of these patients claiming that they are unable to safely meet the patient's needs. The real reason, recently reported on by the Seattle Times, is much more sinister. These patients require more services and are definitely money losers for the nursing homes.

Their answer is to dump them off on hospitals. I have certainly seen this throughout my career. Normally the call from the nursing home comes in the evening or on the weekend when the hospital's regular crew of preadmission screeners are not on duty. Or the patient may simply show up in the Emergency Department straight from the nursing home. Once they are admitted to the hospital as an inpatient and the acute condition is fully treated, suddenly they do not meet criteria to return to the nursing home they came from. These kinds of patients are known throughout the community and soon none of the nursing homes will take them. Again, as with many other components of our uneven healthcare system, it falls upon the hospital to eat the cost of care for these patients.

I have not seen anything in the new healthcare plan that addresses these patients. As Medicaid coverage extends to more indigent patients who are currently uninsured, the numbers of these "in-between" patients will certainly grow. I don't condemn the nursing homes who are struggling in their own right to stay afloat with underfunded Medicaid payments. But abandoning them on hospital doorsteps is not the answer either.

Let's work this issue out before making our problems bigger with an expanded system.

More on this later.

Mark Brodeur