It Ain’t Your Grandma’s Medicaid

ItAintMy grandmother had nearly 12 years of care in a nursing home in rural New Mexico.  Even though my grandmother was a frugal woman, very few people’s resources will extend to cover a 12 year run of care.  So, as so many people do, she ended up on Medicaid —  which is Welfare-based, government-paid care.  And my grandmother had good care.  In that part of the country there was only one nursing home and so private pay and government-pay persons alike were in the same place and receiving the same quality of care.

Today, however, if you think you will be able to get the same caliber of care in a Medicaid facility, you may want to think again…

Demographics and economics are working against those of us who are Baby Boomers – especially those of us on the back half of that generation.  The front edge of the Boomers started turning 65 a few years ago.  Today estimates are that nearly 12,000 persons a day are turning 65 years old.  If we look forward 15 years when these same people are turning 80 years old, we can see a looming care crisis.  Remember the generation behind the Boomers is not that large!  So we have a problem in generating enough care givers to take care of this aging generation for one.  And secondly when the number o workers are fewer, they will tend to go towards higher paying jobs.  Caregiving in the US historically has not been a highly paid or skilled job.  So…what then?

Let me introduce you to the caregivers of the future:

1)      English as a second language – yes, it is possible that we will eventually start importing workers to fill these lower level and lower paid jobs.  Folks who do not have strong English or education credentials yet are anxious to come here to the United States will be more than willing to take these types of positions in exchange for the ability to earn US dollars and/or citizenship.  So…if you are planning on Medicaid-paid care, you can probably plan on a care giver who speaks broken English.

2)      Robotics – ah!  You think I jest…  I do not.  Automation has revolutionized nearly every industry.  Direct and personal care has not benefited from the efficiencies achieved elsewhere because the interactions of humans can be more difficult to predict and thus write code to address.  Nonetheless, recent breakthroughs  in visual and voice recognition along with the continued development of more sophisticated monitoring and delicate hand motions has seen the advent of robotics that can assist with basic activities of daily living like “do you need a drink?” and “let me help you move to the bed.”  We are a long way from Rosie the Robot from the cartoon George Jetson – but give it another 30 years and the back end of the boomers might not be getting care from a human at all.  Medicaid would certainly look carefully at robots if it allowed them to not pay salaries, sick days or benefits to workers!

Finally – you will be foolish to think that Medicaid will continue to provide the same quality of care it always did.  The laws of Supply and Demand are inexorable in a capitalist system.  If there is a high demand for care because the Boomers are aging, and a low number of care givers who are demanding higher wages, and a shrinking group of workers to pay taxes behind the Boomers, then at some point Medicaid will have to find cost savings.  So yes, non-English speaking workers, robotics, or may be just stacking people in wards like they do in Europe.  Where my Grandmother’s Medicaid provided a semi-private room and good care, you and I dear Boomer….well, get ready for a bed, night stand and a curtain.




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