she had kept regular Medicare, she would have been able to get
at least six weeks of service if the visiting nurse had deemed
it so...the HMO...they're saying, 'no, she doesn't need it.'"
- Grace Hixon
has had serious health problems (congestive heart trouble, pneumonia,
tracheotomy) and her adult daughter Grace has tried to care for
her. It's difficult since she works full time and has children.
Neither of them wants Carrie to live in a nursing home. In addition,
Carrie has a few thousand dollars saved and doesn't want to lose
her home or her savings to become eligible for Medicaid. Grace and
Carrie feel that Carrie's biggest mistake was switching from traditional
Medicare to a Medicare HMO.
than 12 million Americans need some form of long-term care, and
the population of the "very old" (over 85) is expected
to triple by 2040.
is the largest source of public money for long-term care, paying
for almost half of the nation's nursing home care. But families
pay, too- out-of-pocket spending accounts for more than 20 percent
of what we spend on long-term care. Long-term care, which includes
a broad range of services for those cannot fully take care of themselves,
can quickly drain a family's financial resources; for example, one
year in a nursing home costs an average of $50,000, and hiring a
home aide part-time can cost more than $10,000 a year.
was envisioned as a "safety net" for those low-income
elderly needing long-term care, but middle-income seniors sometimes
will "spend out" their bank accounts to qualify for the
care they need.
program known as Medicaid became law in 1965 as a jointly funded
cooperative venture between the Federal and State governments to
assist States in the provision of adequate medical care to eligible
needy persons. Medicaid is the largest program providing medical
and health-related services to America's poorest people; it covers
approximately 36 million individuals including children, the aged,
blind, and/or disabled, and people who are eligible to receive federally
assisted income maintenance payments. Medicaid also
covers many middle-class people who deplete their assets in old
age, and is the primary payer for 68% of nursing home residents.
But "depleting their assets" often means turning over
lifetime savings, and not passing it along to their children. Medicaid
has a three-year "look back" period. If someone transfers
their assets to their children less than three years before qualifying
for Medicaid, their eligibility will be delayed by some number of
months, according to a formula. If someone applies for Medicaid
and enters a nursing home, he/she must sell their home and relinquish
any profit unless his or her spouse is still living in it. Like
many similar policies, there are differences among states.
need to listen to the voices of people who are doing home care.
I think we don't do that very much. For one thing, they don't have
the time or energy to speak up very much. They are often just consumed
and exhausted by what they have to do in the way of providing care
for a family member at home. We need to hear them. We need to talk
to them and find out what would be most helpful to them. When we've
done that, and we actually have a project at the Hastings Center
to try to do some of this, what we find are we need more responsiveness
from care givers, from physicians, from nurses, even from home care
health workers. We need to provide respite care. It can make an
enormous difference if I get away for an evening or two in a week
than if I'm locked up seven days and seven nights. To provide a
little respite care, a break, can be a real morale booster and in
some ways a life saver to people." Tom Murray, PhD, President,
The Hastings Center
of Tom Murray's interview
comments about long term and chronic care and related topics by
could create incentives for individuals to save for future long-term
care needs and promote the sale of long-term care insurance. We
could also publicly fund more community-based alternatives to nursing
homes, or expand Medicare to include long-term care.