facility responsibility to the obese

[onthemark]

In my LTC facility, there are a few woman (in their 50's and 60's) who weigh over 400 lbs. Despite their morbid obesity, they eat as much as they want including desserts, and also order take-out food! Doesn't the facility have a responsibility to monitor and curb their intake just as they do with diabetics? What do you think?

[xtxrn, ASN, RN]

Without supplemental insurance, Medicare is extremely expensive for the one who has it (I am one of those! I also used to do the assessments that determined the level of reimbursement for those on SNF care). Medicaid only pays if someone makes less than something like 16K per year... if you make above the "limit", you have what is called a spend down...it is essentially like a deductible. Mine is such that it would not leave me enough for ONLY rent- not even all of that - let alone my premiums for part B, D, and a supplement to cover office copays- since the office can bill for 200 bucks, but Medicare pays 25......for real. No utilities, food, or clothing, haircuts... With supplemental insurance, Medicare, Part B co-pay, a drug plan, and the drug co-pays for what I'm on, I will pay over 700 bucks/month...per MONTH next year. I get 2/3 of my BASE pay from a 2003 rate. 19 years experience. (not that great compared to what y'all want :)). And I'm lucky. Most LTC/SNF patients can't afford the co-pays, so Medicaid gets a LOT of the burden. (for out patient that is totally different part of Medicare, and Medicaid would have to pick up the balance).

People don't understand that you don't just go apply for Medicaid because you can't afford bills. You have to "qualify" - and those between "qualifying" and actually living have to jump through all sorts of hoops, that are looked at when the mood strikes. Disability pays just enough over the cut off to disqualify people. They don't set the limit as some level that still allows people to pay for the supplements/premiums that would cut down what Medicaid has to end up with- eventually, when enough is let ride long enough to get enough for the spend down. Last year (until October) my medications alone were almost 50K. Fortunately I had a drug plan (Medicare approved) that took care of most of that. But that is a clue about the level of bills we're talking about.... it's not just room and board. (Yeah- this is off topic- but it goes towards the whole picture).

These people have to go somewhere. Most have pensions of a few hundred bucks (I used to help the bean counter open the envelopes every month)- because they retired in the 70s, 80s, or were non-working spouses, the monthly amount to LIVE on was often 250-500 bucks.....for the MONTH. Period.

It's complicated. And it's a messed up system. But like others have said- these folks enter LTCs because they can't take care of themselves for whatever reason (not just the SNF folks non-compliant :)). They LIVE in the LTCs....they're not there to 'improve'... some do- but unless they're SNF, it's just their house. And it's not somewhere to be stripped of making decisions. Yeah, it's frustrating.

When employers begin doing weekly drug tests, weights, fitness tests, strength and endurance tests, searches of cars and homes for cigarettes, booze, and whatever.....THEN we can demand compliance by those getting Medicare/Medicaid- because bottom line, it's about insurance (or payor source) getting their money's worth. Medicare is cost-sharing.... you're paying for it now. Medicaid isn't just carte blanche free medical care- not by a LONG shot.

I'm probably not even making sense- I'm tired

[diva rn, BSN, RN]

XT, not only did you make sense...you could write a book and teach a course on this topic.....I hope every one who had read this topic and responded about kicking the obese to the curb...or whatever the affliction...has read this and learned something... about how the system works

at least 2 millions KUDOS to you!!!!!!!

[xtxrn, ASN, RN]

i agree contextually what you're saying...

but i'm also for incentives and consequences, reflecting decisions made.

health insurance/medicare/medicaid benefits can either be more or less costly, depending on decisions/lifestyle.

of course all the kinks would have to be worked out, but let's face it:

there are too many of us who make bad, bad decisions...all in the name of retaining our liberties.

kind of the "because we can" attitude.

and it doesn't just affect them, it affects all of us in the long run.

why should that be allowed to continue?

leslie

To some degree, there is increased cost to people with a big chance of big bills who are one Medicare. There are different levels of supplements available. Having NO supplement is nuts- the co-pays are outrageous. When I was choosing a supplement, it was a crazy process of figuring out what would cover the most. With the pre-existing stuff I've got, I wanted maximum protection- and pay a lot for it. But, I also have no co-pays, ever because I got the highest possible option.

Mediaid isn't available for just anyone who - on paper- can't pay the bills. The application is a PITA...and finding someone who actually answers the phone at the office is a joke. I honestly would not be surprised to find a news story one day that shows that the answering machines finally broke, and that's how they figured out they were paying people who weren't even working. It's not uncommon to wait 6-8 months for an answer on whether or not someone is "approved".... the last time I had to apply for partial assistance, I waited 5 months to hear anything- than another 3 months to make the adjustments because of how long it took to get the refunds figured out. With people (HCPs) who wanted their money (rightfully so) on the horn all the time.

Being in a LTC is a huge loss in and of itself... goodies from home may be antidepressants for some folks. I'm not saying that's good- I'm saying I get why they would cling to the familiar. Everything else about their 'real' life is gone.