The New York Times had an interesting article on the “cutthroat race for Medicare dollars” and how it affects quality of care. Nursing homes are now marketing to sicker people to get Medicare dollars.  At the same time, hospitals are trying to cut costs by pushing some patients out early — like those who have had hip replacement or heart surgery. Not quite ready to go home, they need continuing care somewhere. And for older adults, Medicare usually pays the bill.  Competition for these patients has become intense because Medicare, the health insurance program for older adults, pays 84 percent more for short-term patients than nursing homes typically get from Medicaid, the health insurance program for the poor, for long-term residents.  Most of the homes are not up to the challenge of providing the intensive medical care that rehabilitation requires. Many are often short on nurses and aides and do not have doctors on staff.

A report released in 2014 by the Department of Health and Human Services’ Office of the Inspector General found that 22 percent of Medicare patients who stayed in a nursing facility for 35 days or less experienced harm as a result of their medical care. An additional 11 percent suffered temporary injury. The report estimated that Medicare spent $2.8 billion on hospital treatment in 2011 because of harm experienced in nursing facilities.

The combination of factors has created a bull market in the once-struggling industry as investors clamor to snatch up homes with the most potential to bring in short-term patients. Sale prices of nursing homes averaged $76,500 per bed last year — the second consecutive year of record-breaking prices, according to Irving Levin Associates, which analyzes the senior housing market.

The shifting landscape, some say, marginalizes poor long-term residents with extensive medical needs. “This focus on Medicare, Medicare, Medicare has pushed out people in the custodial care world,” said Anthony Chicotel, a staff lawyer at California Advocates for Nursing Home Reform, who says he fields calls at least once a week from residents who are being evicted because their Medicare coverage, which lasts 100 days, is expiring and the residents will transition to lower-paying Medicaid. “They’re being pushed out, and they don’t have anywhere to go, really, that can take care of them.”

The profit-driven focus on Medicare patients has intensified as many long-term residents moved to assisted-living facilities, and hospitals have sought to discharge patients earlier. On a typical day in 2000, about 9 percent of residents in an average nursing home were covered by Medicare, according to federal data. By 2014, that had risen to 15 percent.

“I think a lot of the time when it comes to managed care, it’s a race to the bottom,” Anthony Chicotel, a staff lawyer at California Advocates for Nursing Home Reform said.

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