By MATT SEDENSKY
AP National Writer

PHILADELPHIA (AP) - New pants to replace Alex Morisey's tattered khakis will have to wait. There's no cash left for sugar-free cookies either. Even at the month's start, the budget is so bare that Fixodent is a luxury. Now, halfway through it, things are so tight that even a Diet Pepsi is a stretch.

"How many years do I have left?" asks 82-year-old Morisey, who lives in a Philadelphia nursing home. "I want to live those as well as I can. But to some degree, you lose your dignity."

Across the U.S., hundreds of thousands of nursing home residents are locked in a wretched bind: Driven into poverty, forced to hand over all income and left to live on an allowance as low as $30 a month.

In a long-term care system that subjects some of society's frailest to daily indignities, Medicaid's personal needs allowance, as the stipend is called, is among the most ubiquitous, yet least known.

Nearly two-thirds of American nursing home residents have their care paid for by Medicaid and, in exchange, all Social Security, pension and other income is rerouted to go toward their bill. The personal needs allowance is meant to pay for anything not provided by the home, from a phone to clothes to a birthday present for a grandchild.

One problem: Congress hasn't raised the allowance in decades.

"It's really one of the most humiliating things for them," says Sam Brooks, an attorney for The National Consumer Voice for Quality Long-Term Care, which advocates for nursing home residents and has urged an increase in the allowance. "It can really be a point of shame."

Especially when an individual has no close relatives or no one able to financially help, the allowance can breed striking need. When Marla Carter visits her mother-in-law at a nursing home in Owensboro, Kentucky, the scene feels more 19th-century poorhouse than modern-day America. With just a $40 allowance, residents are dressed in ill-fitting hand-me-downs or hospital gowns that drape open. Some have no socks or shoes. Basic supplies run low. Many don't even have a pen to write with.

"That's what was so surprising to us," Carter says, "the poverty."

Medicaid was created in 1965 and a 1972 amendment established the personal needs allowance, set at a minimum of $25 each month. Had it been linked to inflation, it would be about $180 today. But regular cost-of-living increases were not built into the allowance and Congress has raised the minimum rate only once, to $30, in 1987.

It has remained there ever since.

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