By JUDITH GRAHAM, NY Times
This article points out the difficulty in financing long term care for the elderly. Experts believe more focus should be on finding ways to provide affordable care within the efforts to reform Medicare and Medicaid. For now, families continue to bear the brunt of the cost associated with caring for the elderly.
The federal Long-Term Care Commission published its full report on Wednesday, but it did little to change the perception that substantial relief for caregivers will be a long time coming.
The commission had endorsed a package of 28 recommendations late last week, prior to the release of the full report. Among other measures, the recommendations call for recognizing caregivers as members of “care teams,” including information about caregivers in patient records, assessing caregivers’ need for support, and making services like respite care more widely available.
But this group of 15 experts couldn’t agree on how to pay for long-term care services needed by frail older adults or people with disabilities. The full report doesn’t change that.
Currently, only those who are impoverished and qualify for Medicaid get significant assistance from the government for long-term care. For the most part, middle-class families are left to bear the burdensome expenses: $18 an hour on average for homemaker services, $19 an hour for home healthcare aids, $3,405 a month for assisted living, $230 a day for a private nursing home room, according to the latest report from Genworth Financial.
How to ease this financial burden was the most important issue facing the commission. In the end, the report proposed two alternatives: some kind of government insurance program for long-term care, or some kind of private insurance option. Then commission members essentially threw up their hands, admitting they couldn’t agree.
When my colleague Paula Span wrote about the commission earlier this year, she asked whether its work would elicit a yawn or a cheer. For many, the answer is neither. Even some commission members feel a sharp sense of frustration and disappointment.
One is Judy Feder, a professor of public policy at Georgetown University, who voted against the commission’s final recommendations on the grounds that they didn’t fulfill Congress’s charge to come up with a comprehensive solution. I asked her about a statement from six of her fellow commissioners insisting that any new long-term care program not enlarge public budgets.
“The current system has a budgetary implication,” Dr. Feder said. “It sticks it to families.”
Another disappointed member is Judith Stein, executive director of the Center for Medicare Advocacy. “The vision in the majority report is not much more than we have now,” she said. “It is, ‘Plan, understand, think about savings and insurance, and provide for those who are impoverished.’ That kind of approach doesn’t meet our long-term care needs now, and it won’t meet them in the future.”
While several of the commission’s recommendations are welcome, they will make a difference only “around the margins,” Ms. Stein said.
Families will bear the consequences, said Ms. Stein and other experts. Elderly spouses will continue to struggle to care for each other, and adult children will strain to balance jobs and the needs of frail parents and their own children. Untold numbers of aging Americans won’t get enough care, and caregivers will suffer from stress and depression, endangering their own health.
If a public insurance program is unaffordable, as several commission members claimed, might the private market supply a solution to the aging population’s need for affordable long-term care? That seems unlikely. Premiums for private long-term care insurance have been rising dramatically, policies are becoming more restrictive, insurers have been exiting the market, and bureaucratic red tape makes it difficult for many individual and families to receive expected benefits.
Financially, the only way to make private insurance work is to spread risk over a wide base of policy holders. But the cost of long-term care coverage makes it unlikely that millions of healthy people will purchase policies. This was the economic calculus that doomed the Class Act, the voluntary long-term care insurance program that was originally part of the Affordable Care Act.
Is there a way forward? The long-term care commission recommended two options: convening a White House conference on aging to consider long-term care policies, and establishing yet another advisory committee to continue its work. But, said Dr. Joanne Lynn, a geriatrician who directs the Center for Elder Care and Advanced Illness at the Altarum Institute, “The administration has shown no interest in having that happen, and here we are on the cusp of the largest generation in history growing old.”
She believes that it’s a mistake to separate long-term care from broader reforms of Medicare and the health care delivery system. The two systems of caring for people with disabilities and older adults need to be much more tightly integrated, Dr. Lynn said. Savings from eliminating inappropriate medical care — by some estimates, as much as one-third of all care — could be used to finance the expansion of long-term care services, she suggested.
As for another commission, is there any reason to hope it will be more successful in tackling critical issues when advocates of smaller government are committed to standing against a new federal insurance program for long-term care that might rely, at least in part, on public financing?
“I think this will be a hard discussion, but it is one that we as a country will have to grapple with,” said Dr. Bruce Chernof, the commission’s chairman and president of the SCAN Foundation in California. He sees the seeds of a potential compromise embedded in the commission’s report. The two primary financing options considered by the commission share “some commonalities,” he said, including agreement on the need for strong public programs and a role for the private sector.
“If you look carefully at these two perspectives, you can begin to see a way forward.”
