Question: Our mother has been in a nursing home for five years. She lived alone after Dad died in 1989, and when she became unable to care for herself, we spent her assets hiring people to help keep her at home and paid for her medicine – averaging more than $800 per month. When she could not continue at home, we sold our family property and spent the rest of her money paying for her care at the nursing home for the past three years. During this time, we continued to pay for her prescriptions, which continued to go up in price.

When she finally qualified for Medicaid two years ago, we were relieved because Medicaid at least picked up the cost of her prescriptions. (We made a mistake by not paying for her burial in advance because she has no money left, and all but $30 of her monthly Social Security check goes to the nursing home. )

Here is our question: We have heard a lot about what effect the new Medicare drug plan will have on Mom, but we don’t understand it. The more people we ask, the more answers we get. Will this new drug program supplement what Medicaid is now paying?

Answer: Unfortunately, because of another poor job of governmental planning, thousands of nursing home residents like your mother may well be at risk and lose coverage for life-sustaining medications come January 1, 2006, when Medicare Part D – probably standing for “Dumb” or “Disaster” – becomes law.

Because of space limitations here, we can give you only a brief overview of the situation facing our institutionalized seniors next January, but if you visit our Website (www.nextsteps.net), we will lead you to more in-depth material about this looming crisis for our most vulnerable adults.

Like your mother, the majority of nursing home residents receive Medicaid that, in turn, provides their prescription drugs. But because your mother is also a Medicare recipient and is therefore “dually eligible” for both Medicare and Medicaid, beginning January 1, 2006, she could well be scheduled to lose her prescription coverage now provided by Medicaid -- unlike regular Medicare recipients who have six months to decide whether to move into Part D or opt out.

Here are some of the problems that require immediate solutions:

1) Part D calls for Medicare beneficiaries to compare and choose from available prescription drug plans (PDPs) and then sign up for the one best suited to their needs; however, large percentages of nursing home residents have capacity impairments and won’t be able to understand the differences. Who will help them?

2) Assuming all dually eligible nursing home residents can be identified in time, each will be randomly assigned a PDP by the Centers for Medicare and Medicaid Services; however, because each PDP offers different medications and uses different pharmacies, this arbitrary assignment may not offer the prescriptions taken by the resident and may conflict with the pharmacy used by the nursing home. While each nursing home resident has the right to change to another PDP, we return to the difficulties of Problem 1, in addition to the delay in making the change. Bottom Line: Those who may not be identified will lose coverage altogether, while those who are identified may have some prescriptions not available to them.

3) Part D does not cover certain prescriptions -- including those used in the majority of nursing facilities for muscle spasms, seizures, anxiety, etc. Since only those states with Medicaid programs covering prescriptions that are excluded by Medicare will continue coverage for these medications, it is a good idea to see if your Mom’s coverage will continue in your state; however, with state budget cuts, it may well be that some states will terminate coverage.

4) Since there will be added administrative duties placed on nursing home personnel and physicians, resident care could be impacted, and, as usual, any additional costs will be shifted on to private pay residents, reducing more quickly the funds available for their care and eroding the long-term care insurance daily rates that insured Americans have purchased.

Taking the NextStep: As we celebrate Mother’s Day and usher in “Older Americans Month,” our Congress has decided to conduct more “studies”; however, final regulations regarding drug coverage for nursing home residents have already been sent to the PDPs -- and these ignore our most vulnerable population. Should Congress and the President choose not to address these problems before January 1st, it is possible that many nursing home residents like your mother, who receive both Medicaid and Medicare, could become even more chronically ill or die prematurely. We suggest that you contact your Congressman and Senators and let them know that the prescription drug program is not working for your loved one. And, with White House Conference on Aging soliciting ideas about how to make the aging process better Conf on Aging Link.

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