With apologies to Charles Dickens for the title, today let’s look at some aspects of long term care.

The specter of “The nursing home” is raised when one has reached that point where one is alone to the extent that family cannot provide in-home care. This is a complicated area that most people do not plan for and either can afford it or cannot. If you can afford it, it just reduces the legacy you leave to your relatives. If you really cannot afford it, e.g., you have nearly nothing but your modest home, then government programs pay for it. If you fall in the middle, it looks to be an expensive activity.

Approximately 70 percent of Americans turning 65 today will need long term care at some point in their lives. This figure comes from both Leading Age (http://leadingage.org), a Washington-based lobbying group that represents nursing and retirement homes and the National Clearinghouse for Long-Term Care Information (http://www.longtermcare.gov).

Who pays now. “On an aggregate basis, the biggest share, 49 percent, is paid for by Medicaid.  On an individual basis, however, ‘who pays for long-term care’ can look very different. This is because people with their own personal financial resources do not qualify for Medicaid unless they use up their resources first paying for care, so-called ‘spending down.’  If you have reasonable income and assets, most likely you will be paying for care on your own” (http://www.longtermcare.gov/LTC/Main_Site/Paying_LTC/Costs_Of_Care/Costs_Of_Care.aspx#National).

I could not find information on this question: How many people who do not qualify for Medicaid need long term care but don’t do it and instead struggle along on their own until their health is so deteriorated that they only need the 90 days provided by Medicare? This seems to be an area worth exploring and one no doubt filled with sad stories.

Private insurers have found it difficult to sign up enough customers for long term care insurance to make the business profitable. A new twist is to pair long term care insurance with whole life insurance (http://www.bloomberg.com/news/2011-05-18/insurers-pair-long-term-care-with-life-to-entice-older-buyers.html). On the other hand, MetLife will stop selling new policies in December (http://www.bloomberg.com/news/2010-11-11/metlife-halts-sale-of-long-term-care-insurance-after-review.html).

Speaking about private long term care insurance Catherine Theroux, a Limra spokeswoman, said, “This is a market that is
challenged even in the best of times. It’s an expensive product and it’s not something people want to talk about.”

The Federal government has taken a small step to fill the gap. This recent legislation is explained in a Bloomberg article, “The health-care law President Barack Obama signed in March 2010 created a program that will pay a daily cash benefit that averages $50 or more to those who can no longer care for themselves, for workers who enroll in and contribute to the program. Details of the plan, called the Class Act, such as the cost of premiums for workers who enroll, haven’t been released, said Lauren Shaham, spokeswoman for Leading Age.” Currently the median cost of a private room in a nursing home is about $213 a day, so the government program really is a small help.

Senator Lindsey Graham, a Republican from South Carolina, said, “The Class Act is a Ponzi scheme that would make Bernie Madoff blush. It’s billed as an insurance program for long-term care, but really it’s just a huge and very costly government accounting trick”  (http://www.bloomberg.com/news/2011-05-18/insurers-pair-long-term-care-with-life-to-entice-older-buyers.html).  Republican viewpoints being what they are we might take this opinion with a grain of salt but it does highlight the fact that few workable solutions are available, that a real analysis of the issues and potentials has not yet been done, and that there is no consensus as to policy.

So, where do health care providers fit in? How can you advise and help your clients/patients? It’s tricky, but given the trials and the options of becoming a participant in the long term care community perhaps the real solution lies in prevention, staying healthy and strong. I sort of hate to say it but perhaps we really do need to follow Former President G. W. Bush’s advice on health care, “Don’t get sick.”