Long-Term Care and Health Care Reform

Congress is moving forward in discussions around health care reform as the President looks to get a bill passed before the end of the year. This is great news for the 40 million uninsured, and will hopefully be great news for many underinsured elders who need, but cannot afford long-term care (LTC) services. Currently, discussions focus on expanding and improving acute care and insuring universal coverage. Many advocates for elder issues have tried to raise awareness around the need to include long-term care in the discussion.

The Elder Economic Security Standard™ Index (Elder Index) measures the cost of home and community-based long-term care services depending upon an elder’s need. These costs can double or even triple what an elder needs to make ends meet. In New Jersey, long-term care costs range from $6,000 to over $46,000, according to the Elder Index. These high costs are minimal, however, compared to the institutional cost in New Jersey, and give ample evidence of why LTC reform is needed; so more elders can age in place.

Most insured elders rely on Medicare and Medigap which do not cover most long-term care expenses. The only options for elders in poor health are to qualify for Medicaid, pay for LTC insurance out-of-pocket (which becomes more expensive as you age) or rely upon the support of family and friends. The last option at times results in caregivers making sacrifices to their own financial, physical and emotional well-being to take care of a loved one.

Incremental change is possible with the Empowered at Home Act and the Community Living Assistance Services and Supports Act (CLASS Act). Of course, overall health care reform should consider the LTC struggles as well. Senator Kennedy’s recent remarks in a Boston Globe Op/Ed on health care reform give many elder advocates hope, “…we'll make it possible for the elderly and disabled to live at home and function independently. Our bill will help them afford to put ramps in their homes, pay someone to check in on them regularly, or any of an array of supports that will enable them to stay in their communities instead of in nursing homes”.

The health care reform debates are the opportune time to address the LTC issue and implement policies that will increase the quality of care while decreasing the medical out-of-pocket expense for elders and we, as advocates, will need to be diligent in voicing our concerns to ensure this happens.