A Forgotten Health Debate: Funding Long-term Care

Donna Taylor's father was the rock of the family. He was the primary caregiver for his disabled wife and her elderly mother. But he got sick and went into the hospital for 10 days. When he got out, he couldn't walk.

Taylor, 41, and her siblings — all of whom had families and children of their own — helped out. But with three elderly, disabled adults in one house, caregiving got expensive. Taylor says her father was surprised at how quickly the family went through its savings.

"He said, 'I worked and I did the right things. I had a pension and I put money away in savings and I had what I thought were the right insurances and the money didn't go far enough.' It just, it just wasn't enough."

When Insurance Isn't Enough

Like most Americans, Taylor's parents believed that Medicare and their private health insurance would pay all the costs of living in a nursing home. It doesn't. Medicare, the federal health insurance for the elderly and disabled, paid the full cost of her father's first 20 days in a rehabilitation nursing home for therapy to try to get him walking again.

But Medicaid, the state and federal insurance program for the poor, does pay for someone to stay long-term in a nursing home. So Taylor told her father he'd have to spend through the rest of his savings, go into poverty, and qualify for Medicaid.

"If you have ever had to look in the eyes of a 64-year-old man who has now had to live in a nursing home, and it's horrible," she says. "And he never ever made me feel bad about that decision. He never said, 'Donna why'd you do this to me?' But he told me, 'This isn't how it was supposed to work out.'"

Taylor's father died in that Phoenix nursing home last year. The nursing home is part of Arizona Baptist Retirement Centers, where Taylor works as an executive vice president. Taylor thinks her father sort of gave up on life.

Better Options

Proposals written into health care overhaul legislation would help families like Donna Taylor's, says John Rother, of the AARP.

One would encourage states to offer more generous benefits to disabled and elderly people on Medicaid who want to stay in their own homes.

And then, says Rother, there's something that could help millions of people. "The CLASS Act," he says, "which was introduced by the late Sen. Ted Kennedy, is a way of putting into place, gradually, an insurance approach to long-term care as opposed to the welfare-based approach we have today."

Workers would choose whether to have money deducted from their paychecks. The deduction would, on average, come to about $65 a month and, when needed, it would pay about $75 a day, according to estimates by the Congressional Budget Office. That's a little less than half of what one day in a nursing home costs now.

"The CLASS Act is not designed to protect people from the cost of nursing home care, very expensive care," says Rother. "It's really designed to help you stay independent at home and to get the services you need: home care, Meals on Wheels, visiting nurse. The kind of thing people do need very often to be able to continue to live independently, and, you know, I think that's actually what most of us want."

Debate Over Cost

How much the CLASS proposal would cost is still under dispute. The way it's written, it's supposed to pay for itself. How much gets paid out depends on how much is collected from those voluntary payroll deductions. But Frank Keating, president of the American Council of Life Insurers, says that's wishful thinking. "It sounds good in principle," he says. "But it is a huge unfunded liability."

The CBO estimated that the CLASS plan would reduce the federal deficit by $58 billion over 10 years. That's why it has a good chance of ending up in final legislation. But Keating says those savings come in the early years when the money's being collected and that it's going to cost trillions of dollars when people start needing the benefits.

A Hard Sell

Keating represents companies that sell private long-term-care insurance. Fewer than 10 percent of older people have bought one of those private policies. It's been a hard sell.

Still, Keating argues it'll be even harder to get young people to buy into the proposed public plan. "It assumes young people will purchase this insurance from the government for a need 40 years down the line," he says. "That simply isn't going to happen. Young people aren't going to do it unless they're mandated to do it, and they're not mandated to do it in this bill and they should not be."

There hasn't been a lot of high-profile debate about the proposals to add long-term care to health overhaul. The reason may be a reflection of the way Americans tend to think about getting old: It's something best not thought about at all.

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