Re-inventing Nursing Homes

May 26, 2015
Rick Gamache


American Red Cross Service Club

As I write this, committees made up of state employees and civic leaders are working out the details of a plan to “Re-invent Medicaid” here in Rhode Island.

A more apt name for their work might be “Re-inventing Nursing Homes” because their proposals will hit nursing homes disproportionally by slashing Medicaid rates for the 6th time in the last 8 years.

I understand that RI, like many other states has a systemic shortfall in Medicaid, which pays for 65%-75% of all people living in nursing homes. At the same time, home and community-based services need to receive more Medicaid funding to grow and meet demand, but there’s got to be a better way than simply “robbing Peter to pay Paul.”

An idea that I have been pushing for many years is to eliminate double rooms in nursing homes, unless people request to share occupancy.

I have college age sons, who move in with virtual strangers each fall. Sometimes they get along with roommates, sometimes they don’t. And it’s one thing if you’re sharing a room for a semester with a complete stranger if you’re both 19 years old. It’s a whole different ballgame when you’re 85, and have lost your spouse, your home and your health, and have no choice but to move into a room with a complete stranger, with just a “privacy curtain” between you.

If all nursing homes eliminated double rooms, Medicaid would be saving between 30%-50% of its total dollars. Infection rates and even medication errors would decrease, as people would not have to share bathrooms, and roommates would never receive the wrong medicine. Oh, and by the way, it would also be the right thing to do.

With fewer dollars going to nursing homes, home and community-based services could grow, and there would be adequate funding available.

But here’s where my proposal starts to take on water: It will cost the same amount to heat, cool and illuminate a building whether it has 100 elders occupying private rooms or 200 elders sharing rooms. And for these fixed costs that none of us control, Medicaid would need an add-on to cover the difference. Here in RI, Medicaid doesn’t want to do this. It’s so much easier to just slash payments.

I have worked in the field of eldercare for over 30 years, and I consider myself to be sort of a “re-inventor” if you will, walking the road less travelled, willing to innovate on everything from deliveries of food services to the creation of better trained care partners. I don’t want to see one single individual living in a nursing home who can make it in their home. But for those that need nursing homes, Medicaid needs to provide adequate funding for their care. Currently Medicaid pays less than $10 an hour for nursing homes to care for frail elders. Is there any wonder why we cannot afford more staff, or more activities or the best equipment, etc.?

The elders of our community deserve far better than this.



2 Comments. Leave new

Jennifer Berg
May 26, 2015 4:23 pm

Referring to a comment of Dr. Thomas, we need to change the way we view our Elders – their virtue to our society has been lost! The rate of pay for employees of Nursing Homes, certainly points to this – very similar to the value we place on our teachers! There was a time when our Elders were given highest respect and their wisdom valued – at the very least we could give them a room of their own!


Amen to this! Long overdue. Not an easy problem to solve, but much harder problems have been successfully solved in our past and no doubt that with your efforts toward awareness and your heart for our elders, this too will be solved by doing “the right thing.”


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