27 March 2023
Living simply is at the heart of Alex Morisey's Quaker religion. The 82-year-old graduated from a good college and spent years working in nonprofit organizations. He helped farmworkers, people living in public housing, and the mentally ill. He was also an aid worker in Central and South America.
Now he lives in a nursing home in Philadelphia, Pennsylvania. But halfway through the month, he has almost no money.
Morisey is one of many Americans living in nursing homes who face a difficult situation. To stay in the nursing home, they must hand over all their income and only receive a small payment, as low as $30 a month, to buy the things they would like. The payment is called the personal needs allowance, also called a PNA.
Alex Morisey listens to music in his room at a nursing home in Philadelphia, on Wednesday, Feb. 15, 2023. (AP Photo/Wong Maye-E)
Nearly two-thirds of Americans living in nursing homes have their care paid for by Medicaid. Medicaid is a health insurance program that is administered by the states. It is paid for equally by state governments and the federal government. In exchange for the coverage, all retirement and other income people on Medicaid would receive is used to pay their nursing home costs.
That means the only other money residents receive from the government is the PNA. The allowance is meant to pay for anything the nursing home does not provide. This can include telephones, clothes or a birthday present for a grandchild.
In some states, the PNA can be only $30 a month and it cannot be higher than $200.
"It's really one of the most humiliating things for them," said Sam Brooks, a lawyer for The National Consumer Voice for Quality Long-Term Care. "It can really be a point of shame," he added.
Medicaid is meant to pay health care costs for poor adults and children or those with other special needs. Medicaid was created in 1965 along with Medicare, the federal government health insurance program for retired Americans.
In 1972, the U.S. Congress established the personal needs allowance, and set the lowest amount at $25.
Had the PNA been linked to inflation, it would be about $180 today. Congress raised the minimum only once, to $30, in 1987.
The small allowance is difficult for nursing home residents who do not receive support from family or friends.
Marla Carter visits her mother-in-law at a nursing home in Owensboro, Kentucky. She sees how poor some residents are. With a $40 allowance, they are dressed in clothing that is the wrong size. Some have no socks or shoes. Basic supplies run low.
"That's what was so surprising to us," Carter said, "the poverty."
She was so upset that she and her husband started a nonprofit, Faithful Friends Kentucky, to give out needed supplies to nursing home residents in the area,
"You bring a soda or a toothbrush and they'll get so excited," she said. "It's so sad to me."
Several states have increased allowances. But most remain low. The American Council on Aging, a non-profit group, says 28 states have allowances of $50 or less. Five states give residents $100 or more each month, including Alaska, which offers $200 monthly. Four states – Alabama, Illinois, North Carolina and South Carolina – remain at $30.
Morisey, of Pennsylvania, entered a nursing home after a fall and, once here, learned his income would no longer be his.
Pennsylvania's allowance is $45, and after a monthly $20 haircut and $5 tip, it is difficult to decide what he should buy with the remaining $20.
"It's the little things," he said. "You don't think about these things until you no longer have them."
His small savings are nearly gone now. Without help from his church, he could not pay for a phone.
I'm Andrew Smith. And I'm Caty Weaver
Matt Sedensky wrote this story for The Associated Press. Andrew Smith adapted it for VOA Learning English.
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Words in This Story
nursing home –n. a place where people who are old and cannot take care of themselves live
allowance –n. an amount of money, usually paid monthly, to someone who does not work
humiliating –adj. something that makes someone feel foolish or ashamed
shame –n. a feeling of guilt, regret or sadness that you have done something wrong
resident –n. a person who lives in a particular place
triple –v. to become three times bigger
quadruple –v. to become four times larger
church –n. a Christian religious group