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Long-term care includes a range of services for people who have functional limitations or chronic health conditions. Their needs include sub-acute, rehabilitative, medical, skilled nursing and supportive social services. Long--term care services are provided in a variety of settings, including nursing or assisted living facilities, respite care, adult day care, and home- and community-based settings.
Who uses long-term care?
Two out of every five Americans will need nursing home care sometime in their lives. At present, more than 1.5 million Americans live in the nation's 25,000 assisted living facilities.
The average age of a nursing home resident is 79, 75 percent of those over age 65 are women. About 63 percent are disoriented or memory-impaired. The elderly population is growing fast and, with the baby boom generation aging, nursing home populations will increase exponentially over the next 15 to 20 years.
The fastest growing segment of our population is those over age 85. One out of every four in that age group lives in a nursing home.
Why has the need for long-term care increased?
One reason the demand for long-term care has increased is because people are living longer than they ever have before. Also, families are geographically scattered; employment and educational opportunities, among-other things, have spread families from coast to coast. Time, travel expenses, and other responsibilities make it nearly impossible to provide the care older family members need. Another reason is that the primary caregivers in most families are women, and today more women work outside the home. Finally, grown children are unable to care for their aging parents because they, too, are often in need of some degree of assistance.
How much does long-term care cost?
Nursing home costs vary depending on location and the level of services required. On average, nursing home care costs about $43,000 per year, or $118 per day.
Does Medicare cover long-term care?
Medicare does not even begin to address the needs of a society that is living longer and longer. When Medicare was first developed in the mid-1960s, we had only limited knowledge regarding the special needs of elderly people, including chronic care needs.
Why does Medicaid pay the nursing home care costs for so many elderly nursing home residents when Medicare is supposed to take care of the elderly's health care needs?
While originally intended to meet the poor's health care needs, Medicaid became America's long-term care system by default because the nation lacks any comprehensive long-term care program. Many elderly middle-class citizens must rely on Medicaid to pay for long-term care because they have exhausted virtually all of their life savings and assets to pay for their care. Most spend down their assets within one year of being admitted to a nursing home.
Medicare, on the other hand, pays for the elderly's doctor visits, emergencies and short term illnesses, but not for long-term care. Medicare does offer a limited benefit for nursing home care, but only following a three-day hospital stay.
In such cases Medicare will pay for the first 20 days of nursing home care. On the 21st through 100th day of their nursing home stay, Medicare patients must pay the first $89.50 per day of costs incurred for their care. After the 100th day, patients must turn to Medicaid or their own resources to pay for their care.
What about estate planning so that the state will take care of you if you really need it?
Congress recently enacted legislation to prohibit professionals from counseling people in ways to shelter assets for the purpose of qualifying for Medicaid.
Even more important is understanding the limitations of Medicaid and other public programs. Long-term care insurance guarantees individuals freedom of choice—not only freedom to choose the setting for their care, but the peace of mind of knowing that they will receive quality care and services.
What are the odds I will need long-term care insurance?
The actual claims statistics on homeowner's and automobile insurance are substantially lower than data from surveys on long-term care risk. A recent analysis by the consulting firm Deloitte & Touche noted that 60% of people over age 75 will need such services. Long-term care is clearly the number one risk facing elderly Americans—and it's the one for which Americans are least insured.
What about recent legislative changes in health care?
Nearly all of the discussions and legislation in Washington have been in the opposite direction from any national health plan. The recently signed legislation sent a clear message to people that each one of us must take responsibility for the cost of our own long-term care.
Is there a solution?
Yes. Congress needs to help educate Americans about the risks of long-term care, its costs, the limitations of government long-term care assistance, and steps families can take to protect themselves and their assets.
Congress should encourage families and individuals to buy long-term care insurance by establishing federal tax incentives and passing federal consumer protections that prohibit misleading sales practices and require insurance companies to offer only comprehensive, high-quality policies.