By Rosenblatt, Robert A.
Aging Today , Vol. 29, No. 3
What should the United States do about the millions of Americans who may be unlucky enough to have physical or mental ailments that would render them unable to care for themselves? Should they get financial help from their fellow taxpayers if they need to hire caregivers at home, or pay the average $77,000 a year or more it costs to live in a nursing home?
One might think this issue would be a hot one in the presidential campaign. The leading edge of the biggest generation in U.S. history-the 76 million born in the years 1946 through 1964-is heading into the age when the need for long-term care becomes a painful reality. But neither of the presumptive nominees, Sen. John McCain, R-Ariz., and Sen. Barack Obama, D-Ill., has uttered barely a word or offered a proposal on the subject.
FEAR OF COST
The reason seems simple. Long-term care, now provided overwhelmingly by family and Mends, would cost billions of dollars if the government offered it as a new benefit for the middle class. "The big fear does seem to be cost," said Stephen C. McConnell, who directs the new policy and advocacy programs for The Atlantic Philanthropies in Washington, D.C. "This is a problem the government isn't paying for, except through Medicaid and, in small ways, under Medicare. The burden is largely on families, and policymakers are reluctant to develop a program that would cost billions. There also has not been enough of a groundswell of noise to force action on the issue," said McConnell.
The United States has a veritable army of caregivers-as many as 34 million Americans help provide care for someone over the age of 50, a family member or a friend. Another 11 million individuals help care for someone between ages 18 and 49, according to a 2004 joint report by AARP and the National Alliance for Caregiving.
Family caregiving is costly in money, time and often the emotional and physical health of caregivers. A November 2007 national survey of caregivers showed that they spent an average of $5,351 annually on caregiving, more than 10% of their median income of $43,026 a year. Caregivers were able to afford this financial strain by "cutting back on leisure activities (49%), vacations (47%), reducing or stopping saving for their own future (38%), and deferring major purchases or home improvement projects (34%)." Conducted by the National Alliance for Caregiving and Evercare, a division of the United Health Group, the study, Family Caregivers -What They Spend, What They Sacrifice, is available online at www.caregiving.org/pubs/data.htm.
The federal government will help with the cost of nursing home care, but only after someone has fallen into poverty. Once people pull their life savings down to no more than $2,000, they have access to Medicaid, the federal-state healthcare program for lowincome people. Most people age 65 or older in nursing homes began as paying patients and only qualified for Medicaid when they became impoverished. This sad story, which professionals in aging know as spend-down in the jargon of welfare, won't change anytime soon. That's because members of Congress and presidents don't want to shift more of the financial burden from individuals and families to taxpayers.
Surveys show that most Americans mistakenly believe Medicare will cover the cost of so-called custodial care in a nursing home. It is not true, of course. If someone breaks a hip and has it repaired, Medicare will pay for rehabilitation in a skilled nursing facility, with care for up to ioo days and the first 20 days without charge. The key is that a person must have a medical condition that is being treated-and that providers expect will improve. However, if someone goes into a nursing home with Alzheimer's disease or, perhaps, the cognitive impairment from a stroke, Medicare won't pay the tab, even for patients who are unable to care for themselves.
REMEMBER LONG-TERM CARE '88?
Exactly 20 years ago, a drive to make long-term care a top political issue came from Long-Term Care '88, a coalition of 140 national organizations, including consumer and labor groups, funded by AARP and Villers Foundation (now Families USA). …