Stepping Up to the Long-Term Care Crisis

It starts with a call that a loved one is in the hospital after being in a serious accident. Sometimes it comes from having chronic health conditions that minimize daily functioning as one grows older. These life-changing events present individuals and their families with a new set of needs and challenges that require a variety of human capital and financial resources to redefine and maintain daily living on their terms.

The likelihood that you or someone you love will need this kind of support is greater than you may think. While nearly all Americans hope to remain in their homes as long as possible—enjoying good health and living independently—the reality is that 70 percent of people over 65 will need some form of support to assist them with daily activities at some point in their lives, for an average of three years.

Over the next two decades, Americans will reach that milestone at a rate of nearly 8,000 a day. The older people become, the more likely they will need long-term care, and with advances in medicine and technology, we are living well into our 80’s and 90’s.

Americans currently receive supportive services from a variety of sources, ranging from unpaid family care and home health care providers, to continuing care retirement communities and nursing homes. However, many seniors are without family assistance or simply do not want to be a “burden” on their loved ones to care for them—leaving them with few affordable options.

Meanwhile, the cost of paying for long-term care continues to grow. In 2011, national spending on long-term care reached $211 billion, which includes government payors as well as personal out-of-pocket spending. This number is not surprising given that the MetLife Mature Market Institute reported that the annual cost of nursing home care exceeded $82,000 on average, while the cost of using home health aides for roughly 20 hours a week is nearly $22,000 per year.

Most American families—even those of middle- and higher-incomes—are unprepared for the full extent of these costs. Few have the means to purchase current private long-term care insurance products, and the number of companies offering these products is shrinking. Medicaid currently pays 62 percent of national long-term care costs, but most seniors are not eligible for Medicaid assistance with long-term care until they exhaust, or “spend down” their personal finances first. Forcing people into poverty in order to qualify for care is neither compassionate nor sustainable policy.

Health care policy-makers across the spectrum agree that we must find a new way to address this burgeoning national challenge, especially as a growing amount of evidence suggests that Medicare’s highest expenditures are for patients with multiple chronic conditions and functional impairment. Gaps in appropriate long-term care can force seniors with immediate health care needs into emergency rooms and other acute-care settings, where they often receive expensive, and sometimes inappropriate, care.

Policy solutions that address these needs from the perspective of supportive services may ultimately play a major role in addressing those concerns, and a number of national and state initiatives in both the public and private sector are aiming to develop sustainable, integrated care networks for Americans in need of long-term care. Individual communities are also stepping up, with many building multi-provider networks that allow local seniors to access care in a variety of settings.

The Affordable Care Act tried to address this growing national concern as it included the Community Living Assistances Services and Supports (CLASS) Act, a provision that called for the creation of a national long-term care insurance program. However, the Obama administration halted implementation in 2011 after deeming the program was unworkable and financially unsustainable in the long-run, and it was ultimately repealed in the American Taxpayer Relief Act of 2012.

The repeal of the CLASS Act was followed by Congress’ call for creation of the Commission on Long-Term Care, a 15-member, bipartisan group tasked with making recommendations to Congress on long-term care for adults of all ages with functional needs. This commission, with a charge to report back to Congress later this year, has the potential to develop meaningful policy solutions that will help all Americans age with dignity, choice, and independence.

Today, millions of Americans require sustained assistance with daily activities and health care needs, but many have neither the means nor the support networks to meet their needs. The time has come for the health policy community to develop and implement meaningful, cost-effective solutions for a critical issue that affects nearly every family and has major implications for the U.S. economy and national entitlement reform.

Bruce Chernof, M.D., is president and CEO of The SCAN Foundation, an independent, non-profit public charity devoted to transforming health care for seniors in ways that encourage independence and preserve dignity. In February 2013, House Democratic leader Nancy Pelosi appointed Dr. Chernof, along with several others, to the bipartisan Commission on Long-Term Care, created earlier this year and responsible for developing a plan to establish, implement and finance a comprehensive set of long-term care services.

11 replies »

  1. People these days have options like purchasing private insurance and relying on federal programs like Medicaid, Medicare and PACE. For me, the first option is the most reliable since it provides comprehensive coverage. It is costly but there are ways to bring the cost down. When it comes to federal programs, the government should do something about this quick. People are clamoring for a long term care program that they can greatly benefit from. I hope they can can come up with another one, similar to CLASS ACT. But this time, it will push through and can provide assistance to people who are in dire need of help.

  2. I wanted to share this inspirational story with people dealing with elderly parents or loved ones who can’t seem to take care of themselves as we’ll anymore. I hope this inspires and helps someone.
    I took a job at a gym last year. At first, it was just a job. People come in to lose weight, get muscular, etc. But then I met two clients who were elderly who are brought there by their relatives to try to get them better. One is Norma. When Norma first came to the gym she was in a wheelchair, could barely speak, and to me, was basically an invalid. It broke my heart to see her being picked up and put into each weight lifting machine and assisted to do the pull downs, chest press, leg extensions. She didn’t talk, her eyes were pretty distant, and she just didn’t seem all there mentally.

    I stopped working weekends which Saturdays were Norma’s days to come to the gym and Strength Train with our personal trainers so I hadn’t seen her in about 3 months. One weekend another girl went on vacation so I had to cover her weekend shift and I saw Norma again for the first time since meeting her. I was shocked! Tears of amazement welled in my eyes as I saw her heading towards the door of the gym, walking with a walker instead of a wheelchair. When she came in and I asked her how she was she spoke to me, with shining eyes and enthusiasm, reintroducing herself to me. I was in awe of the change! She was just a shell of a human 3 months ago and now, here she is, walking, talking, and able to get on the leg press machine and do 26 reps of 50lbs! Not only physically is she getting strong enough to go from a nursing home to an assisted living facility where she will have her own bathroom and more independence but she is mentally sharper!
    I spoke with her neice who has been a client of ours for years and who had decided to bring her to our gym about how amazing Norma is doing now and she said it is because of the strength training. Her atrophied muscles are building back up and she has more energy and zest for life now. I cried. It was so beautiful seeing the transformation.

    If you have a loved on in the same condition, please, consider getting them a personal trainer who specializes in Strength Training. It will completely transform your loved ones life for the better. Strength Training has also been shown to increase bone density in the elderly so that they are not as likely to break bones. Google, learn, and don’t give up!

  3. In Holland we already found something for this problem. Instead of working till 65 years old, we have to work now to 67. So with people getting older, they also need to work longer. This is the only good sollution, in my eyes, we already found for this problem. With people getting older its just impossible to take care for them for 2 decades and even beyond.

  4. Correction: assisted living facilities which are somewhat cheaper, not someone cheaper.

  5. The latest estimate I saw for the cost / value of long term care provided by family members was $450 billion in 2012. That was in a Wall Street Journal article earlier this week. The same article pegged the paid cost of care at $275 billion of which about $65 billion was paid out of pocket or through long term care insurance policies. That total may also include the cost of home healthcare but I’m not sure.

    On a positive note, if one can call it that, about 7.4% of the 75 and older population lived in a nursing home in 2006 which was down from 8.1% in 2000 and 10.2% in 1990. Some of this decline is due to the growth of assisted living facilities which are at least someone cheaper and allow for considerably more freedom and independence for residents. Advances in technology from more sophisticated scooters and chair lifts and new medical devices along with minimally invasive surgical procedures are making it possible for more and more people to cope outside of an expensive nursing home setting. Simple things like grab bars in the shower, panic buttons to summon help and in home cameras to allow remote monitoring are also helpful. If we can keep people healthier for longer and use technology to allow them to cope in their home as their health deteriorates, we can reduce the percentage of elderly people that eventually need to be in a nursing home as well as shorten the time that they need to be there.

    The bottom line is that while financing long term care is a huge and expensive challenge, there are at least some positive forces at work here.

  6. I’m glad Dr. Chernof is bringing up this important issue. Will be interesting to see what the Commission comes up with.

    Also, he says national spending on long-term care was $211 billion in 2011. This seems like an underestimate of our current investment, since I think it doesn’t take into account the unpaid care provided by family and friends: there are an estimated 30-40 million Americans providing unpaid care to friends and relatives, and a few years ago the value was estimated at $375 billion.

  7. apologies to the author Dr Chernof (not Cernof) for typo in my post

  8. “Most American families—even those of middle- and higher-incomes—are unprepared for the full extent of these costs”- …… – “Forcing people into poverty in order to qualify for care is neither compassionate nor sustainable policy”- says Dr. Cernof

    Of course the conservative right will see this as an opportunity to place the LTC burden onto families- especially women in families- which is a regressive strategy.

    Dr. Rick Lippin
    Southampton, Pa

  9. After we’ve turned Medicare into Medicaid (with even more vigilant provisions against “asset shifting”), no more problem. Make everyone “spend down” into penury before getting any benefits. Right, Paul Ryan?

  10. After working on LTC policy issues exclusively for five years and then representing providers and others over the last ten, I often say: Long term care is the issue of the future and always will be.

    By that I mean on the basic level, individuals and families will always look at the issue say, that is something I have to deal with in the future, but there are too many other priorities today. Then crisis hits and its too late.

    Similarly, policymakers will say, we need to do something about this, but its too expensive. We’ll deal with this in the future when there are no wars, no structural deficits, no whatevers.