PHILADELPHIA — Alex Morrissey’s torn khakis will have to wait for new pants. There is no money left even for sugar free cookies. Even at the beginning of the month the budget is so low that fixodent is a luxury. Now, halfway through, things are so tight that even a diet Pepsi is a stretch.
“How many years do I have left?” asks Morrissey, 82, who lives in a Philadelphia nursing home. “I want to live them as best I can. But to some extent, you lose your dignity.”
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Across America, hundreds of thousands of nursing home residents are locked in a dire straitjacket: pushed into poverty, forced to hand over all income and left to live on a $30-a-month stipend.
In the long-term care system that subjects some of society’s most vulnerable to daily humiliation, Medicaid’s individual needs allowance, as the stipend is called, is the most ubiquitous, yet the least known.
About two-thirds of US nursing home residents are paid for by Medicaid and, in turn, all Social Security, pensions and other income is rerouted to go toward their bills. Personal Needs Allowance is meant to pay for anything not provided by the household, from a phone to clothes to a grandchild’s birthday present.
One problem: Congress hasn’t raised the allowance in decades.
“It’s really one of the most disrespectful things to them,” says Sam Brooks, an advocate for the National Consumer Voice for Quality Long-Term Care, which advocates for nursing home residents and urges an increase in alimony. “It really could be a shame.”
Especially when a person has no close relatives or is not able to help financially, alimony can create a striking need. When Marla Carter visits her mother-in-law at a nursing home in Owensboro, Kentucky, the scene feels more like a 19th-century poor house than modern-day America. With only a $40 allowance, residents are clad in ill-fitting hand-me-downs or hospital gowns that drape open. Some don’t have socks or shoes. Basic supplies run short. Many do not even have a pen to write.
“That’s what was surprising to us,” says Carter.
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Medicaid was created in 1965 and a 1972 amendment established a personal needs allowance, set at a minimum of $25 per month. If it was added to inflation, it would have been around $180 today. But regular cost-of-living increases were not included in the allowance, and Congress raised the minimum rate only once, to $30 in 1987.
Since then it has been lying there.
Some politicians have tried to fix the problem, including Rep. Jennifer Wexton, a Democrat from Virginia, who introduced a bill in 2019 to raise the minimum allowance for Social Security to $60 and cement annual increases. It was not even heard.
“I was shocked,” says Wexton. “It’s about dignity for these people.”
Faced with federal inaction, states have taken it upon themselves to raise allowances. Yet, most are short lived. According to a state-by-state survey by the American Council on Aging, most states — 28 — have allowances of $50 or less. Only five states give residents grants of $100 or more each month, including Alaska, which is alone in offering $200 monthly, the maximum under federal law. Four states – Alabama, Illinois, North Carolina and South Carolina – remain on the $30 minimum.
“It’s gone as soon as I get it,” says Chris Hackney, a 74-year-old resident of a nursing home in Durham, North Carolina, who spends his $30 monthly allowance on a few items like body wash, toothpaste, deodorant and ” The convenience it used to provide, but wipes and diapers have been cut down on.
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Down the hall, 56-year-old Jayne Cox gets an occasional bag of chips from the vending machine and shrimps to add to the collection plate at church. The condition of his neighbors is even worse. “It’s like a fight for them to survive another day,” she says.
With no financial shackles, nursing home residents find that the little freedom they have evaporates even more, the chance to take a taxi to see a friend, a newly purchased book To get lost in, or to escape the monotony, the cafeteria with some take-out food out of reach.
Even after two years of institutional life, this is a stark truth for Morrissey.
With every $45 in allowance he receives, a monthly juggling act begins.
Can his razor last a little longer to top off the refill? Can he squeeze a little more out of the fixodent tube? Has he cut corners enough to get some aftershave or peanut butter crackers?
“It’s the little things,” he says. “You don’t think about these things until you have to.”
A lifelong Quaker, he has always preferred to live simply, and accepts his position with a smile. But it doesn’t take much, he says, to ask for a soda.