Long Term Care problems won’t go away

Busy week and little time to blog, but a quick note on this Kaiser story reporting on a SCAN Foundation poll on long term care needs/perceptions/preparations in California, sent my way by Brad Flansbaum. The article nicely summarizes the surprise many families receive when it comes time for a loved one to need LTC:

Long-term care costs can surprise many families who expect Medicare to cover their needs. After a hospital stay, Medicare will pay for 100 days of nursing home care, but after that, families are on their own or are forced to spend down their assets to become poor enough to qualify for Medicaid.

Only 35% of Californians correctly understood that Medicare does not pay for extended nursing home care and only 1 in 5 understood the Medicare home health benefit (they think it is more generous than it is). So, Medicaid is the default nursing home payer in the U.S. and the program pays around half of the nation’s nursing home bill. Block granting Medicaid in a way that reduces fairly costs for the program will pit LTC services for the elderly and disabled against the need for acute care insurance for children and pregnant women, and say to states “tag; you’re it!”.

We desperately need a more coherent LTC policy in this country. Private LTC insurance offers no hope of a population based answer. Families are left to stand in the breach, doing the best they can. As I have said before, one of the worst outcomes of the ACA debate was the demise of CLASS in a way that treated those provisions only through the lens of deficit reduction. Deficit accounting is important, but cannot answer all important policy questions.

CLASS wasn’t a deficit gimmick, it was an attempt to set up a self sustaining LTC insurance benefit that could have helped people age in their homes and delay NH admission. Like so much of health reform, critics know far more about what they are against than what they are for.

The question remains: how will our country insure against the need for LTC?

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University https://academiccouncil.duke.edu/ . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

6 Responses to Long Term Care problems won’t go away

  1. Gene cutler says:

    This is simple and intuitive…”progress” has created the perfect storm: living longer, delaying mortality increasing morbidity, extending longevity faster than society or nature can assimilate ( financially and cognitively unable to keep up), children having children later and moving further away…or worse, being forced,to move in. As a culture we can’t provide adequate skilled medical care or pensions, much less increasing and extended custodial care. This isn’t going away. CLASS tried, but quickly realized it couldn’t . Private sector jumped in…business abhors a vacuum ….and the laws of supply and demand have taken over. As always, the realistic, forward thinkers..pragmatic and yes, financially astute realize…..GET IT NOW.

  2. gene says:

    ….and those in the private sector realistic enough to perceive what’s going on, and wise enough to know from experience that they didn’t accumate/protect assets by carrying inapproprite risk….what do you suppose they’re doing at this time? How do you think their consultants are advising them? what happens when they sit down at the holiday table…view their aged

    parent(s) on the left and their home-for-the-holidays children on the right?

  3. Pingback: New book on Long Term Care « freeforall

  4. Pingback: Access to Medicare home health, SNF eased « freeforall

  5. Pingback: The thing that worries me most about the long term health system outlook | freeforall

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: