35. Thirty-five. There,
does that look bigger?
35
dollars is the monthly personal needs allowance (PNA) an individual in
California gets to keep when living in a nursing home (SNF-Skilled Nursing
Facility) under MediCal. This is to cover ALL of their personal needs,
including clothing, shoes, utilities, entertainment, postage, transportation,
gifts, personal services like visiting the hairdresser, makeup, personal
hygiene products, a meal out, cigarettes, and anything else of a personal
nature. This amount hasn’t changed for 30 years, and is not the same in all
states. Arizona has the highest allowance, over $100, while California is among the lowest, just $35.
I
first became aware of the reality of this situation in 2006, while working as
the ombudsman at a SNF. I received a complaint from Joan, a SNF resident, that
the facility suddenly started keeping all but $35 of her Social Security
income, when she had previously been allowed to keep $600. I was new to the
job, and had to refer back to my training materials, but I recalled hearing
something like that in training. I just had never seen the reality of what that
meant. During the first 20 days in a SNF under Medicare, there is no co-pay.
Theoretically Medicare will cover up to 100 days in a SNF, but not for what
they term “custodial care.” Once they determine you’re not going to improve,
the free ride is over.
But what if you can’t go home because you
can’t take care of yourself? What if you can’t get out of bed, or to the
bathroom, or dress yourself? If you don’t have the $6,000+ per month to pay for
a nursing home, you’re out of luck. And really, if you had a spare $6,000 a
month hanging around, why would you ever CHOOSE to go into a nursing home? In
my 8 ½ years as an ombudsman, I never met a single person who said they’d
rather be in a nursing home than in their own home. So low income people in
need of nursing home care must go under MediCal, where the state picks up the
tab for the SNF.
When I explained to Joan that the facility had
correctly determined her personal needs allowance, she asked, “How will I ever
be able to buy a pair of shoes?” I asked her what others do. She said their
families provide for their needs, but that she has no family, so what is she to
do?
Joan
is a crazy big spender (not). The facility charges $12 a month to hook up her
TV for basic service, $8 for lifeline phone service, and $15 for a once-a-month
visit to the hairdresser at the end of the hall. That leaves a big fat ZERO for
everything else. One could argue that a person doesn’t really “need” TV or a
phone, but imagine being held prisoner in a tiny room with nothing else to do.
Any touch with reality and the outside world would quickly dissipate.
We have asked the state why they don’t
increase the PNA, and the answer is that they can’t afford it. The huge outlay
just for current SNF care is already beyond any reasonable budget, so there is
NO CHANCE that they will increase the PNA anytime soon. The state’s MediCal
costs are huge. Another 50 bucks a head couldn’t even be considered material
in the accounting sense of the word, yet when such a bill passed, it was vetoed (AB 789 September 3, 1999) because it wasn't in the budget.
In 2011, Joan told me she needed a new
pair of sandals, as she hadn’t gotten any new shoes for 4 years. She required
an adjustable sandal, of a good quality, in order to work with her misshapen
feet. Fortunately for Joan, when I told her story to a representative of Beck’s
Shoes in San Jose, they agreed to donate a pair. Joan was allowed to come to
the store and be fitted for an appropriate pair of sandals at no cost. She
reported that she was treated with exceptional respect, as if she were a paying
customer. She was grateful. It is now 3
years later, and she’s still wearing that same pair.
 |
| 2009-birthday at the SJ Art Museum |
Joan doesn’t have any children, nieces or
nephews. She has made friends at the SNF, and consciously presents a positive
attitude in spite of her difficulties. Observing this, I got the idea to
organize a birthday party for her, inviting my friends and family to join in.
The first year we went to Lisa’s Tea & Treasures for a lovely ladies
luncheon. Joan was beside herself, as this was her first birthday party… EVER.
When she said it was the best day of her life, if made me glad we had done it,
but almost ashamed for the bounty in my own life. The next year we went to the
SJ Art Museum, where Joan had previously worked as a docent, then lunch at the
Fairmont. She liked that a lot, but wanted to bring a friend the next year, so
we arranged to have a picnic at the perc ponds, and that has been her preferred
party place ever since. This is Joan’s 80th birthday celebration.
 |
| Let there be cake!!! |
 |
| Happy Birthday to ME! |
My
friends and family have heard me tell stories of the struggles of the nursing
home residents, and are very compassionate. This year they decided instead of
exchanging Christmas gifts like we usually do, we’d all chip in and make a
deposit to Joan’s account to help pay for her TV and phone for the year. When I
gave her the card announcing the gift, Joan was speechless. She wrote thank you
notes to all the donors the very next day.
I’ve
been thinking a lot about the haves and the have-nots in our society. Then
there’s the “need-mores” that never seem to be content, no matter how much they
have. And our corporate “people” who rig the system to make sure their own
pockets are lined, all the time scorning the poor, suggesting that they should
just work harder and they too can be rich. Tell that to Joan, who worked
managing a law office for many years, only to see her savings drained when she
had to hire a caregiver in order to remain in her home, then when the money ran out, had
to move to a nursing home, where she gets to keep the grand total of $35 a
month for anything she wants. Right.
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