Politicians Avoid Ltc Quiet Giant

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POTOMAC SOURCES

Long-term care (LTC) is the quiet giant huddling at the corner of the room, and all the politicians are carefully avoiding seeing it. Proposals and discussions abound on the best way to bring basic health insurance coverage to the 46 million Americans who don't have any, but nobody wants to consider the growth of the population needing nursing care and the huge bills that will come with that care.

Today, with the focus on states developing their own healthcare plans, there's a great deal of chatter about whether to require an individual mandate, how much to tax business, and what sort of penalties to impose on people who don't voluntarily buy a policy. Yet nobody is asking what the United States should do about families unlucky enough to have someone needing nursing home care. Should states or the federal government provide some extra financial help with skilled nursing costs before elders and their families run out of money? To date, the answer has been, "Tough luck. You're on your own until you are poor enough for the welfare program called Medicaid."

It doesn't help that about 70% of federal and state spending on LTC continue to flow to nursing homes and related institutions rather than home and community-based care alternatives that may be less costly. Also, LTC insurance remains a promising but problematic product that is not for everyone, says "Comparing Long-Term Care Insurance Policies: Bewildering Choices for Consumers," a 2006 report from the AARP Public Policy Institute, available online at www.aarp.org/research/longtermcarelinsurance/2006_ 13_ltci.html.

In the last year, Congress has decided to pull its helping hand even farther away by making it harder for people to qualify for Medicaid when they are in nursing facilities. Members of Congress want Americans to buy long-term care insurance and spare the taxpayers from picking up the tab in U.S. nursing homes, now about $70,000 a year. Meanwhile, affordable assisted living options are also few and far between.

GOOD NEWS, BAD NEWS

LTC presents a good-news, bad-news situation for the boomers, the 78 million Americans born from 1946 through 1964. The good news is that older people are healthier today than their counterparts in earlier generations. Research at Duke University and elsewhere has shown that disability levels have declined with each successive survey of those 65 or older. A person age 85 in 2006 is likely to enjoy much better health and selfsufficiency than an Ss-year-old in 1986,1966 or 1946.

According to the report Older Americans 2004-a compilation of the latest available numbers compiled by the Federal Forum on Interagency Statistics-in 1985, among every 1,000 Americans ages 65 and over, 54 were in nursing homes. By 1999, the figure had declined to 43 per 1,000. For those age 85-plus, the number of those admitted to nursing homes per 1,000 declined from 220 in 1985 to 183 in 1999.

However, a typical nursing home resident today is a widow age 85 or more with multiple physical problems. …