Temple: Nursing Home Care for Family Farmers

In Protecting Access to Nursing Home Care for Family Farmers, Natalie Temple (Gonzaga Law School) explores the challenges aging American farmers experience when faced with the need for nursing home care. Due to the “land rich, cash poor” nature of most farmers, the need for elder care forces many farmers to choose between selling off farmland or going without care.

Temple explains that since the 1980s, Congress has sought to impose restrictions on Medicaid access for wealthy Americans seeking to exploit government benefits for elder care. However, due to their unique financial position, farmers have been adversely affected. Asset calculations for Medicaid eligibility include farmland values, and farmers often lack private funding due to the harsh costs associated with private long-term care insurance. Temple states that because 85% of the 2 million farms across the US are family owned, the issues surrounding long-term nursing home care uniquely affect family farmers in rural communities.

Temple argues that as their assets and experiences do not fit the mold of the ordinary American, family farmers are often overlooked by policymakers. Farm assets represent generational identity, cultural heritage, and economic survival, and farmers build their lives around their work. Additionally, rural areas often suffer from a lack of accessibility to medical care. Long-term care facilities are lacking in rural communities, with 18% of them having no Medicare-certified nursing home. As such, the family farm “way of life” and rural access-to-care considerations do not align with urban-centric values and policies. 

In response to these issues, Temple proposes a Medicaid carveout for family-owned farmland and assets, both for determining Medicaid eligibility and enforcing Medicaid estate recovery policies. This type of carveout would increase access to nursing homes in rural areas and protect family farms from having to sell assets, alleviating the fear of losing their farms in exchange for long-term care. Temple contends that this carveout would have minimal costs in the grand scheme of things, while giving states the ability to protect their family farms.