The Third Age: Now’s the time to ponder long-term health care

Original Source By ANN GOWANS Neither presidential candidate has spoken about long-term care when discussing plans for reforming our health-care system. It seemingly is not a real issue for them. This is a bit easier to understand, perhaps, from the point of view of the younger candidate, but one would think that the older of the two would give it some room in his speeches. Then again, perhaps he feels uncomfortable with anything that puts him close to the ‘elder’ age group. The fact does remain, however, that there are millions of Americans who will experience either mental or physical problems that take away their ability to care for themselves. Stephen McConnell, director of policy advocacy for the Atlantic Philanthropies, says the average bill for a year or more of nursing-home care exceeds $77,000 a year. If home care is available, will the bill be close to this? No one seems to know. Baby boomers are headed into the time when their need for long-term care can become a painful reality. I guess their research tells them they don’t need to fuss about this issue. Most long-term care is now provided by friends and family and would cost billions of dollars if the government foolishly offered this new form of help to middle-class families. Unfortunately, many of these folks are caught in the middle of raising, educating and simply feeding their teenage children, to say nothing of worrying about them finding employment. When their elderly parents turn up needing help, that only adds insult to injury. I’m sure you know the term ‘spend down.’ It refers to the system we now have to take care of the majority of our middle- and below-income elders when they need care. These folks are admitted into a nursing home when they come out of a hospital stay or are referred by a physician into rehabilitative or nursing care. Everyone in the family assumes that Medicare will pick up their bills. Medicare will pay for nursing home care up to 100 days, the first 20 days without charge. This is only when, for example, the patient has a medical condition that is being treated and is expected to improve. However, if someone is admitted into this kind of care for cognitive impairment from a stroke – or any kind of dementia, for example – Medicare will not pay the bill even for patients who are unable to care for themselves. The federal government will help with the cost of nursing-home care but only until someone has spent his or her savings from all sources down to no more than $2,000. (If a spouse is living in the home, that holding is exempt). They then are expected to have access to Medicaid, the federal-state health-care program for low-income people. Most people in nursing homes started their stay by running out their Medicare reimbursement – as well what funding they could afford from their own pockets – and only qualified for Medicaid when their resources ran out. They then have effectively “spent down.” A relatively small number of Americans have long-term care insurance, the kind that might cover some of the cost of hiring caregivers at home or paying for an extended stay in a nursing home. What many consumers do not know is that not all insurance is the same, and some policies do not cover these problems well. So long-term care insurance is part of the solution, but, McConnell says, “even the insurance industry doesn’t expect to sell policies to more than about half the adult population, and that is optimistic.” These policies are relatively expensive and grow more so the older the insured. Another issue is that when we might not need something for 30 years, we often loathe the idea of spending money on it. If I were advising Sen. Barack Obama, I would suggest he bring up this issue. This would be especially true if Sen. John McCain decides the issue is too hot and too expensive for him to approach. Columbian Ann Gowans has a doctorate in social gerontology and medical sociology. She has worked and taught in the field for 25 years.