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Long Term and Chronic Care

"If 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

Carrie 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.

More 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.

Medicaid 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.

Medicaid 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.

The 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.

"We 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

More of Tom Murray's interview

More comments about long term and chronic care and related topics by our experts

WHAT TO DO?

* We 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.

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