The Economist had an interesting article about how campaign contributions from the nursing home industry influence policy in Louisiana.  ” No interest group showers more money on the Bayou State’s politicians than nursing homes and their owners. Indeed, the last two governors together collected over $1m in donations from nursing homes; Louisiana legislators and other state officials have raked in many millions more.”

“For nursing home owners, the investment in politicians has paid off handsomely. Every year, the fees the state pays them to house elderly and physically disabled people rise at rates that substantially outpace inflation. Meanwhile, their main competitors—home- and community-based health providers, which provide part-time care for the disabled in their own homes—have seen their rates cut repeatedly.”

In 2015, the governor considered an overhaul of Louisiana’s policies, one that would have shifted more money to home-based providers and away from nursing homes. The needed reform was dropped when the nursing home industry complained—an episode recounted in a recent report by the Advocate newspaper.

“Surveys have shown that given the choice and some help with basic tasks, most older folks would rather stay in their own homes than be institutionalised. That option also tends to be cheaper. Most states have been going in this direction: in a typical state, about 60% of the Medicaid budget for long-term care goes to nursing homes; the other 40% goes to home- and community-based care. The ratio has been getting closer to par every year. But in Louisiana, 77% of that pie goes to nursing homes, a share that has grown in each of the last four years.”

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