Affording end of life and long term care

Sep 10, 2012

A new study in the Journal of General Internal Medicine finds that nearly a quarter of Medicare recipients spend more than their total household assets on out-of-pocket health care costs in the last five years of their lives. That’s in co-payments, home health care, things Medicare doesn’t cover.

(Did you know that Medicare doesn’t cover long-term care? If you’re really poor, Medicaid will cover some of it. But to be eligible you have to meet strict guidelines. And you pretty much have to use up all your own resources first.)

This study also found that the biggest expenses were for people with Alzheimer’s, who often need special care. What’s more, the Alzheimer’s Association says that Alzheimer’s care sometimes gets billed under a mental health code, which means Medicare will only cover a portion.

Demographically speaking, we’re about to be hit by a wave of older people. Boomers are aging, plus we’re all living longer. Here in Rhode Island, we’ve already got the nation’s biggest percentage of people over 85. And among older people we’re seeing the rise of some devastating mental and physical illnesses, including Alzheimer’s, which can run up huge medical bills.

Those facts, and some other recent articles (such as this one the looming crisis for Medicaid and long term care for the elderly in the NY Times) and stories got me thinking: what are we going to do about the cost of long term care for this quickly graying population?  How are we going to take care of an aging population with more and more special needs? Are we headed for a crisis?

We may be. I’ve been emailing with Donald H. Taylor, Jr., an associate professor of public policy at Duke University, who blogs and publishes a lot on long term care. I asked him if the Affordable Care Act might address some of the looming LTC issues, and here’s what he told me via email:

ACA [the Affordable Care Act] won’t do much for long term care. The CLASS [Community Living Assistance Services and Supports Act] provisions could have, but are on hold because they do not have a means of forced risk pooling like an individual mandate. Block granting of Medicaid [which Republicans would like to see] as a means of saving federal dollars would be a disaster, and pit the young poor v. elderly and disabled who depend on Medicaid to pay for LTC.

So, what’s the solution? Well, not everyone will need the most expensive and highest level of care in old age: nursing homes. Thank goodness, because nursing home care is incredibly expensive. There may be more efforts to help people stay in their own homes or communities by providing home health care workers, for instance. There’s an effort underway right now in Rhode Island to address the state’s growing Alzheimer’s needs in a more comprehensive way, including helping caregivers and coordinating better care in the community.

But the bottom line is, or at least it seems to me, that the burden of care will continue to fall on families, who do the yeoman’s work of it now. And they may not only have to burn through all of their loved one’s money to pay for health care but even begin dipping into their own when that runs out.

Are you providing some kind of care – in your own home or another – to an aging family member? What’s it been like?