Making do on just $50 a month
Nursing home residents on Medicaid must cover expenses the home doesn't--from stationery to food of their choice--on a tight allowance. The federal minimum hasn't risen in 18 years.

By Maria Sudekum Fisher
Associated Press
Published September 18, 2006


OLATHE, Kan. -- It's just a trip to the grocery store, but for 81-year-old Luella Stevens it brings back fond memories of her old life in Arizona before she started bouncing around nursing homes and counting every penny.

It's like those days before her husband, Cyrus "Steve" Stevens, died, leaving her without enough money to take care of herself and make payments on their mobile home and two cars. That was in 2001, back in Tucson, home for 45 years.



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Stevens has her grocery list carefully culled from the Dillons newspaper ad: ice cream $1.99, Kraft Swiss singles $1.77. The total adds up to $24.79. It's the end of the month, and she has about $25 left, so money is tight.

"I had to give up hot dogs and hot dog buns this week so I could get hairspray," she says, her Long Island accent still obvious even though she left New York almost five decades ago.

As a nursing home resident, Stevens receives a $50 monthly Personal Needs Allowance, or PNA, from Medicaid to cover expenses not provided at the home. She spends it on stamps, stationery and food for an occasional dinner in her room when she wants a little privacy or doesn't like what's being served in the dining room.

In Arizona she received $86 a month. But when she moved to Kansas to be closer to her daughter, the allowance for the state's 11,000 low-income nursing home residents at that time was $30 a month, the federal minimum since 1988.

"You lose so much of your dignity anyway when you move into a nursing home," she said. "But having to make do on $1 a day, that was appalling."

She heads to the customer service desk to get a Dillons discount card.

"Fruit first. We don't get fresh fruit," she announces as she heads over to the produce section. She picks up a few peaches and plums and carefully puts them in a plastic bag.

"October is going to be a tough month," she says. There are two family birthdays in October, and the birth of her second great-grandchild. It would be nice to get expensive gifts, but on $50 a month, the birthday gifts alone will eat up $20. Still, as tight as her budget is, she probably will spend a little more than $10 on the baby.

Across the country, about 65 percent of the nation's 1.4 million nursing home residents require Medicaid assistance because they--like Stevens--have few, if any, assets. And like Stevens, they have turned over the bulk of their income so Medicaid will pay for the cost of their care in the nursing home. The monthly allowance is doled out from those assets.

There have been attempts in Congress to raise the $30 federal minimum, but they all have failed. States also have the option of raising the PNA, and Kansas did so in July--to $50.

Eight states, including Alabama, Hawaii, Illinois, Oregon and Virginia, have not updated the amount beyond the 1988 level.

That means thousands of nursing home residents have to fend for their personal items on $30 a month, said Lori Smetanka, director of the National Long Term Care Ombudsman Resource Center in Washington. Another 12 states have raised the PNA to $40 a month or less, she said.

Stevens' grocery cart is scattered with a few items: fruit, cheese, hairspray, Diet Coke--a 12-pack for $2.99--cream cheese and chocolate mint ice cream. She grabs a bag of small bagels.

"They're already sliced, which is good since they won't give us knives, like we're going to do something bad with them," she says.

Once she has picked up the last item on her list, a small microwave pizza that she'll have for dinner that night, she realizes she has about $5 left. Stevens heads for the candy aisle. She wants chocolate licorice, but Dillons is out. She picks up two small bags of chocolate candy, two for $5.

At the checkout, the bill is $25.60, and Stevens digs around in her purse to find the extra change.



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