What is the cost of nursing home care in Virginia and how do you know?

Can you imagine walking into Kroger and there are three prices on a jug of milk. What if the tag said:

  • $2.00 if you are a single Mom
  • $3.50 if you are 65 or older
  • $6.00 if you have a job and or retirement account

Wouldn’t you be surprised? Upset? Bothered by this?

Well, in healthcare, in Virginia nursing homes (and all other states for that matter) this is exactly what happens. The “cost” of nursing home care depends on how and who is paying. State Medicaid will pay one daily rate; Medicare another; and the facility will charge a third – higher daily rate to anyone who is private pay. 

And if that wasn’t enough of a perplexing method of payment, recently the nation’s largest nursing home pharmacy (the company all the large chains use to order and supply medication to patients) Omnicare was forced to pay back $28 million dollars in settlement of federal kick back litigation here in Western Virginia. What? Let me explain.

Thankfully, there are laws that prevent healthcare companies from encouraging doctors to prescribe their products unnecessarily. You don’t want patients taking medicine they don’t really need because the doctor or nursing home was financially incentive-zed to prescribe them, do you? Of course not. And this is exactly what Omnicare was caught doing – getting paid for recommending a certain medication to doctors and nursing home patients. On paper the kickbacks were labeled as “educational funding” in attempt to avoid judicial and criminal scrutiny. 

Thankfully, a whistle blower turned Omnicare in and our local US Attorneys accepted the case. 

In sum – we have a long way to go in for-profit healthcare models. When facilities can charge different rates for the same service, and there is incentive along the way to prescribe medications for patients – patients lose. 

Yes, when profits are placed before people, patients lose. 

So – what is the cost of nursing home care? It all depends who is paying. 

Lauren Ellerman

Lauren Ellerman

In 2011, Lauren Ellerman was named "Young Lawyer of the Year" by the Roanoke Bar Association for her work in the community. To speak with Lauren about your personal injury case, contact her at lellerman@frithlawfirm.com.