Issue: Long-term Care & Medicaid


Norma Harwzinske just got home from the hospital. Her husband, Stanley, has Alzheimer’s disease. He fell and broke his hip at Van Duyn Home and Hospital and she was in the waiting room during his surgery.

“He fell on Halloween and in the hospital they told me I couldn’t take him home,” Norma says of Stanley. “He’s reached the point where there’s nothing more I can do.”

The Harwzinskes live in Syracuse. Medicaid is the primary payer source for his care at Van Duyn, a nursing home on Onondaga Hill. Stanley, 84, is in his ninth year of Alzheimer’s. Norma, 82, cared for her husband at home until a recent hospital visit.

Harwzinske is among 10 million elderly and disabled people who get long-term care under Medicaid nationally. In Onondaga County, that’s roughly 3,100 Medicaid beneficiaries.

They, like Harwzinske, are the flesh-and-blood examples of the country’s dilemma over how to cope with the growing need for long-term care. The reasons: the rising number of people who need long-term care and the cost of providing it. In New York, there’s even more pressure on Medicaid. Recently, Gov. David Paterson has proposed major cuts to Medicaid.

Medicaid is the primary program for long-term care in the U.S., and it will continue to be that way in the future, says the Kaiser Family Foundation, one the country’s top research groups on health care policies. The foundation estimates that the need for Medicaid will continue to grow because of the high cost of long-term care.

Consider these statistics:

  • The average cost of a nursing home in the United States is $70,000 per year.
  • Medicaid accounts for 44 percent of nursing home expenditures and 41 percent of total long-term care expenditures.
  • Nationally more than 10 million Americans—that’s one in every 30—require long-term care. Of the 3,100 Medicaid beneficiaries in Onondaga County, 1,900 get care in nursing homes. The other 1,200 get at-home care.
  • Nationally, the total cost of long-term care under Medicaid in 2006 was $109 billion.
  • In Onondaga County, roughly 58 percent of Medicaid costs are for long-term care. That’s a total of $54 million.

Medicaid is a government-funded program that has two components: one provides healthcare for poor people. The other provides long-term healthcare for the elderly and the disabled.

Medicaid is a joint program between federal and state governments. In New York, counties share some of the cost. New York is one of the few states that pushes Medicaid costs down to counties through taxes. For example, in Onondaga County, Medicaid costs account for 53 percent of the local property tax and 8 percent of the county’s budget.

Medicaid is the only public program in the United States that pays for long-term care. The only other way to pay for long-term care is with private insurance.

To qualify for Medicaid, people have to be poor. This means that individuals can have few assets of savings and investments—no more than $2,000 in most states. People have to spend down their assets until they have so little money they meet Medicaid’s poverty requirement.

The reason for an increased need for care is that people are living longer and becoming more frail in old age, says Deborah Freund, a political science professor at Syracuse University. She specializes in Medicaid and other public health programs.

Problems with long-term care have been around for a long time, without any solutions, Freund says. And the future of long-term care looks grim, Freund says. She predicts “poor outcomes, poor service and stretching the dollar further.” A lot of this has to do rising costs of labor, equipment and food, Freund says.

Another problem is that Medicaid doesn’t offer many choices about where people receive care, says Richard Mollot, of the Long Term Community Care Coalition, an advocacy group for long-term healthcare. The coalition is based in New York City, but it advocates throughout the state.

“Oftentimes, people could receive care at home, but a lack of options means they go into a nursing home,” Mollot says.

In New York, Medicaid faces the prospect of even more financial trouble. On Nov. 10, Gov. David Paterson proposed cutting Medicaid funding by billions of dollars to narrow the state’s budget deficit. But state legislators failed to take action on the proposals.

Van Duyn

In Onondaga County, the Van Duyn Home and Hospital is one of the largest providers of long-term care. It’s a special case because it is a county-owned nursing home. As a public facility, it is more dependent on Medicaid reimbursements to provide care.

An increased need for long-term care is stretching Medicaid funds thin. At Van Duyn, Medicaid is the primary payer for 73 percent of residents.

At another large, local nursing home, Loretto Sedgwick, Medicaid is also the primary payer for a majority of residents. Because of this, Medicaid cuts will likely hit Van Duyn and Loretto harder than nursing homes with more residents who pay privately.

In the Van Duyn nursing home, the resident areas are homey. Wooden rocking chairs with floral-printed cushions line some areas of the hallways. Film posters of Audrey Hepburn and Paul Newman – iconic movie stars to the generation who make up most of the home’s residents – decorate the walls. Bubblegum machines pop up throughout the building for visiting children. Many residents can be found playing Keno and bingo or in the barber and beauty shops in Van Duyn.

Van Duyn was built in the 1970’s and the building’s design hasn’t been updated much since. “I call the area by the elevators ‘the cement jungle,’” says Maureen Cerniglia, nursing home administrator, with a laugh. She points out the building’s exposed cement walls and the “retro” nurse stations with their yellow Formica counters.

Most nursing homes have two rates: a private rate and a Medicaid rate. At Van Duyn, the private rate is $270 per day. The Medicaid rate is $175 per day.

If the state’s proposed cuts take effect, it will reduce Van Duyn’s funding by more than $2 million, Cerniglia estimates. The cuts will most likely result in staff reductions too, because 70 percent of Van Duyn’s operating revenue goes towards staff salaries. The administration has thought about switching to cheaper brands of equipment so staff cuts would be less drastic, Cerniglia says.

But either way, administrators at nursing homes face hard choices. “Basically, you have to decide between quality of care and your staff,” Cerniglia says. “If the changes go through as planned, it’s going to really hurt nursing homes.”


Solutions for the long-term care dilemma are complicated and expensive. Some advocates call for a move away from the larger institutionalized care in nursing homes. And other experts argue that younger people will need to anticipate their long-term care needs and buy insurance to pay for it in their old age or if they’re disabled.

For a move away from nursing homes, many advocates for long-term care would like to see more, smaller facilities. That would give long-term care recipients more choices. For example, Van Duyn has roughly 500 residents at any given time.

“A community facility might have the same number of residents as just one floor of Van Duyn,” Cerniglia says.

For younger people, private insurance is a possible remedy for Medicaid’s financial trouble, says Deborah Freund, political science professor at Syracuse University. “We might have to mandate long-term care insurance because we don’t have a tradition where families take care of elders instead of putting them in nursing homes,” Freund says.

If state legislators in Albany do make Medicaid cuts, the future of long-term care is unclear in the county, says Patrice Gile of Onondaga County’s budget office.

“If the cuts happen, that would have to come from local dollars somehow,” Gile says. “It’s not like the cost of caring for people in nursing homes goes away.”

In Syracuse, Norma Harwzinske cooked dinner for herself after getting home from her husband Stanley’s surgery. She answered phone calls from family and friends calling to ask how the surgery went. She doesn’t have time to worry about the future of Medicaid, she says. She’s glad it’s taking care of some of Stanley’s medical expenses now.

“I’m so thankful we have Medicaid coverage, because we knew this day was coming,” Norma says, “That he would require this kind of care.”

(Jamie Munks is a senior with dual majors in newspaper and political science.)


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