Why Are Rural Nursing Homes Closing?
By Richard P. Holm, MD
During one of our weekly hospice meetings, the discussion turned to the burden of finding an opening in a facility for one of our patients. Mr. A belongs to the working-poor segment of our society, just above official levels of poverty and yet he cannot afford health insurance and primary care, let alone the private cost of an assisted living center or nursing home.
Our patient is still living at home, has no family support and is in trouble. His progressive cancer has caused an inability even to do activities of daily living such as bowel and bladder care. He now only has Medicaid and his hospice nurse and social worker is not able to find an assisted living center or a nursing home that will take him in.
It’s no surprise that care facilities in South Dakota find it financially difficult to accept Medicaid patients like Mr. A. Without Medicaid expansion, facilities lose money when caring for them. If a nursing home has too many Medicaid patients, it simply can’t stay afloat. This explains why nursing homes, especially in rural areas, are closing.
The national solution was to expand Medicaid coverage to increase payments for services using federal dollars. Some states initially elected not to expand Medicaid, for fear they would become dependent on this money. However, many states have changed their position, and to date, 36 states now accept the national funding from expanded Medicaid, including North Dakota as of 2014, and Nebraska in 2018. So far, 14 states have not expanded Medicaid, including, South Dakota, Kansas and Wyoming.
If Medicaid was expanded in South Dakota, more than two billion dollars of federal health care funding would come into the state, helping healthcare coverage to 55,000 South Dakotans, in turn, helping to prevent rural nursing homes from closing. This would help Mr. A, and people like him, get comfort care during their dying days.
Medicaid expansion passed last year in some majority Republican states indicating that this is a bipartisan issue. A recent poll revealed that approximately 80 percent of South Dakotans want Medicaid expansion. In my opinion, fearing dependence on federal money does not justify letting our rural nursing homes close or letting the working-poor go without care.
Bottom Line: It is time for those within the political arena to expand Medicaid.
Richard P. Holm, MD is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.