Warehousing Residents with Dementia

McKnight’s reported on a recent study published in Alzheimer’s & Dementia which highlights a troubling reality in the nursing home industry: dementia patients are admitted to lower-rated nursing homes at disproportionate rates compared to non-dementia patients. The data shows that only 52% of dementia patients are placed in four- or five-star facilities, while 23% end up in one- or two-star facilities. For context, 59% of non-dementia patients are admitted to higher-rated homes, with only 18% in the lowest-rated facilities.

The heart of this issue is the longevity of dementia as a disease and its progressive nature. This not only makes care more difficult, but also presents issues due to Medicaid playing a dominant role in funding long-term care. Since dementia is a progressive condition, it requires extended stays in nursing homes. While initial costs may be covered by personal savings, private insurance, or Medicare, once these resources are exhausted, the patients and their families may be forced to turn to Medicaid, which is the primary payer for long-term care in the U.S., covering nearly two-thirds of all nursing home residents, including a disproportionate number of dementia patients.

Medicaid patients are less profitable, so facilities that are spoiled for choice aren’t going to be willing to admit them. Higher-rated facilities that prioritize profitability will limit their acceptance of Medicaid-funded patients, reserving spots for private-pay or Medicare beneficiaries that will be more profitable for them. This leaves Medicaid patients, which includes many dementia patients, with few options but to seek care at lower-rated facilities. These facilities are more reliant on Medicaid funding but at the cost of operating with fewer resources and lower staffing levels.

The nature of dementia care severely complicates these issues. Caring for dementia patients is more complex than caring for other patients. Dementia care requires specialized training, higher staffing, and environments that ensure safety and quality care. Lower-rated facilities struggle to meet these demands, which creates this dangerous misalignment where the patients who require the most care end up in the  facilities the least capable of providing it.

Dementia patients in lower-rated facilities are at greater risk of neglect and even exploitation. Improvement is extremely difficult when those at the top are only focused on profitability and maximizing reimbursement rather than providing quality care to those who need it most.