When People Are Evicted from Long Term Care, What Is Next?

CW: Death

Shirley Holtz, 91, relied on a walker to move around. She had dementia and was under hospice care. Despite her age and fragile health, Holtz was evicted from the assisted-living facility she had called home for four years because she relied on government health insurance for low-income Americans.

Holtz was one of 15 residents ordered to leave the Emerald Bay Retirement Community near Green Bay, Wisconsin after the facility stopped receiving payment from a state-sponsored Medicaid program. Emerald Bay is not alone. A recent wave of evictions has impacted dozens of Wisconsin assisted-living residents who rely on Medicaid to pay their bills – an increasingly prevalent practice, according to industry leaders.

According to Wisconsin Public Radio, the facility had to increase the rent for residents who were paying out of pocket before making the decision. Lexi Wood’s 96-year-old grandmother, Millie, had spent her life savings to pay her rent to Emerald Bay. She had moved to the facility two years ago. In that time, she spent $96,000 on rent.

About 4.4 million Americans receive long-term care through Medicaid, the state-federal healthcare program for low-income Americans.

Residents in assisted-living facilities, marketed as a friendlier, more appealing alternative to nursing homes, are perilous. While federal law protects Medicaid recipients in nursing homes from eviction, it does not cover residents of assisted-living facilities, leaving them with limited options if they are kicked out. Residents in Wisconsin who entered facilities on Medicaid, as well as those who depleted their private resources after moving in and then enrolled in Medicaid, have been impacted.

But evictions have become so common that some states, including New Jersey, have enacted policies to curb them. Nationally, state ombudsman programs for long-term care received 3,265 complaints related to evictions from assisted-living facilities in 2020. That data does not detail the reason for the evictions. However, ombudsmen said most complaints arose after staff decided that a resident’s needs had become too complex to be handled at the facility.

Advocates for assisted-living residents are concerned that the pandemic’s economic conditions are exacerbating the situation in some parts of the country. Profits in assisted-living homes are jeopardized by a lack of staff and significant increases in labor costs, inflation, which raises the cost of goods, and increased interest rates. Occupancy rates, meanwhile, are still below pre-pandemic peaks.

The sector blames evictions on a lack of Medicaid funds. Reimbursements made under federal waivers that allow states to use Medicaid funds on care for the elderly outside of nursing homes are not keeping up with escalating expenses, according to industry groups.

Moving elderly people out of a familiar setting can negatively impact their physical and mental health. Experts call this transfer trauma. According to The Hospital Employees’ Union in British Columbia, studies show that relocating different patients between settings increases the mortality rate when compared to those who were not relocated. The data showed patients who were relocated had a mortality rate that was 1.99-3.76 times higher than those who remained in their facility.

According to Shirley Holtz’s daughter, the eviction caused alarming changes in her mother that her family noticed. Shirley lost 15 pounds and stopped walking. Sadly, Shirley Holtz passed away on April 3. She died three weeks after leaving Emerald Bay and moving into the new facility.

The Centers for Medicare & Medicaid Services increased regulatory rules for nursing home discharges and transfers in 2016, stating that residents cannot be evicted for nonpayment while applying for Medicaid or appealing a Medicaid denial. A year later, the agency announced an initiative to prevent improper nursing home discharges, recognizing that “some discharges are driven by payment concerns, such as when Medicare or private pay residents shift to Medicaid as the payment source.”

Medicaid is a lifeline for millions of Americans. For some of America’s most vulnerable residents, Medicaid is the only insurance they have. People die without the care they need. Nobody should be refused care, due to finances.

Sources:

Engelhart, Katie. “Some Nursing Homes Are Illegally Evicting Elderly and Disabled Residents Who Can’t Afford to Pay.” NBCNews.com, NBCUniversal News Group, 29 Nov. 2019, https://www.nbcnews.com/news/us-news/some-nursing-homes-are-illegally-evicting-elderly-disabled-residents-who-n1087341.

Robinson, Victoria. “A brief literature review of the effects of relocation on the elderly.” Burnaby, British Columbia, Canada: The Hospital Employees’ Union of British Columbia (2002).

Rowland , Christopher. “Assisted-Living Homes Are Rejecting Medicaid and Evicting Seniors.” The Washington Post, WP Company, 6 Apr. 2023, https://www.washingtonpost.com/business/2023/04/06/seniors-assisted-living-medicaid-eviction/.

Schulz, Joe. “’It’s Heartless’: Green Bay-Area Assisted Living Facility to Evict Medicaid Recipients.” Wisconsin Public Radio, NPR, 7 Feb. 2023, https://www.wpr.org/green-bay-area-assisted-living-facility-evicting-medicaid-recipients.