After months of working in skilled nursing facilities, I couldn’t understand why one particular patients continued to reside there–well actually several residents. This one guy is completely independent in his Activities of Daily Living. So independent, in fact, that he regularly leaves the facility and returns intoxicated, as I learned recently. I had previously inquired as to why he has not been discharged to assisted living and I was told that he couldn’t afford it. This is issue #1 in our system. Medicare will pay for skilled nursing at the level of hundreds of dollars a day; however, it will not pay for assisted living at <$100 per day. Many of my patients could likely qualify for transfer to assisted living, but remain chilling at a higher cost to our system simply due to finances. Wouldn’t it behoove all of us to pay for the lowest required level of care?

Upon further investigation of this patient, I learned that a nurse discovered his name on the list of convicted sex offenders in the area, which further explains the complicated discharge process. He cannot enter into homeless shelter, find work or other services due to his criminal record.

So he remains in a skilled nursing home. Perfectly capable of contributing to society and seemingly wanting to; however suspended in limbo. Why not pay far less money for this man to live in a special homeless shelter for those with criminal records? Why not pay far less money for him to be in an assisted living facility?

It makes no sense, people. Sigh.

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