Issue: Longterm Care


If you live to be 65, you have a 40 percent chance of living in a nursing home.

In Onondaga County, that nursing home will cost about $96,000 per year.

Those are vivid examples of the nation’s need for long-term care, say experts on aging and health care. And if nothing is done, experts fear the problem will keep growing.

“With the growing aging population it’s arguably unsustainable for the government to continue to pay for this,” said Anne Tumlinson, author of a key study on needs of the elderly and the senior vice president of Avalere Health, a company which consults on health care with employers.

The need for long-term care for the elderly and disabled is both a human and financial problem for the United States. Baby boomers are growing older and many will need long-term care. For many, the care comes in nursing homes. The expense is often devastating to families and is a growing drain on government funding. And the country needs more alternatives, say experts.

For many, nationally and locally, Medicaid has become the main funder of long-term care. Medicaid is a government-funded program that provides health care for poor people and long-term care for many of the elderly and the disabled in nursing homes who have spent their own income.

Consider these longterm-care statistics:

  • About 3.1 percent of the U.S. population  — about 1.3 million people — are in skilled nursing homes, according to the 2010 Census.
  • In New York state, approximately 118,000 people are in skilled nursing homes.  Around 76 percent of those in nursing homes — or 89,000 people — pay using Medicaid.
  • In Onondaga County, Medicaid pays for the nursing-home care of 1,950 beneficiaries, according to county department of social work chronic care unit officials.
  • Nationally, about 41.2 percent of Medicaid’s spending goes to nursing homes for longterm care, according to the independent research group Kaiser Family Foundation.
  • Statewide, the percent is a little lower with more than $6.8 million — or 31.5 percent — of the state’s Medicaid budget going to nursing homes for longterm care.
  • Nationally, the average cost of a nursing home care is about $74,000 according to a Metlife insurance company report on long-term care.

In Onondaga County, the cost is even higher: At Van Duyn, the county-owned nursing home, for example, residents who pay out of their own pocket spend about $117,000 per year. The majority of Van Duyn residents — 82 percent — are covered by Medicaid at about $66,000 per year. On average, according to state reports, the cost of nursing home care in Onondaga County is $96,000 a year.

The elderly end up on Medicaid through a “spend-down” requirement, said Debbie Freund, a healthcare expert and president of Claremont Graduate University. People will often sell their homes and other assets so they can qualify for Medicaid coverage. They must spend down their own money until they are poor enough to qualify for government help through Medicaid.

One reason for the growing need for long-term care is longer life expectancy, say experts on long-term care.

But as they live longer, the elderly become more frail, said Richard Herrick, president of New York State Health Facilities Association.  It is the trade group representing the nursing home industry. Of the elderly and disabled, Herrick said, “They’re presenting themselves to the nursing homes later in their lives, therefore their needs are more critical.”

Among the proposals to cope with the need for long-term care:

Expand government programs

For some experts, the solution to the long-term care problem is by expanding programs already in place by the government. This includes Medicaid and Medicare, the federal insurance system for all those over 65 or with disabilities.

The new health care law, enacted under the Obama administration,  would expand the number of elderly eligible for Medicaid. The law would make eligible for Medicaid those with an income elow 133 percent of the federal poverty level would be eligible, beginning in January 2014. That’s an income of $30,657 for a family of four. Under the Medicaid provision in the law, the government would fully fund the additional elderly for three years instead of sharing the cost with the state.

But the law is being contested by several states and the U.S. Supreme Court will rule in summer 2012 on whether the law is constitutional.

Another option is expanding the coverage offered by Medicare, the tax-supported health insurance program for those 65 or older.

Syracuse University healthcare expert Madonna Meyer favors this option. It works with a system that’s already in place, she said She’d like to see the tax rate taken out of paychecks for Medicare go up a little bit and put the extra into a fund for national long-term care. A similar provision was dropped from the new health care law, she said.

Expand home-care program

Some groups are trying to find ways to keep the elderly out of expensive nursing homes and help them stay at home and receive care there. One such program is the National Aging in Place Council. The trade association is based in Washington, D.C., and has chapters around the country. The chapter closest to Syracuse is on Long Island.

The council has in-home service providers to help the elderly stay in place, said Marty Bell, communications director for the council, in an email interview. “Obviously our population prefers to remain in their homes for as long as possible,” Bell said.   “Nursing homes and hospital are not the most comfortable places.”

In-home care can help relieve the burden on Medicaid and Medicare, Bell said. But in-home care is also expensive. To help make in-home care a more viable option, Bell suggested expanding government programs to cover in-home care.

Encourage private long-term care insurance

For many conservatives and libertarians, the favored solution is long-term care insurance sold in the private market. But that’s been slow to gain popularity. A 2009 study by the  Kaiser Family Foundation found that private, long-term care insurance only covered about 10 percent of all seniors.

Among the reasons, according to Tumlinson, the author of the study: People in their 40’s and 50’s may not realize they need it later. People assume they’re covered for long-term care through other types of insurance. Or people think it’s too expensive.

And since people don’t buy it, the market for it becomes unstable. Premiums go up so insurance companies can get by. Sometimes insurance providers completely drop long-term care from their coverage.

“The question is now what?” Tumlinson said. “And I don’t know the answer to that.”

(Meghin Delaney is a junior with double majors in magazine journalism and political science.)


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