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Many proposals have been forwarded as a means to bolster long-term care:
· Develop or expand public programs aimed at supporting family caregivers, such as the National Family Caregiver Support Program, funded by The Older Americans Act.
· Make long-term care insurance premiums tax deductible as a way to encourage higher rates of participation.
· Make reverse asset mortgages more widely available.
· Find a way to make the CLASS Act viable, the proposed federal long-term care insurance that is currently in legislative limbo.
· Amply home health care services as a less expensive way to deliver care for those who can postpone moving to a skilled nursing facility, such as magnifying meal delivery and transportation services as part of the Older American Act and expanding home health care services through Medicare. The Family Caregiver Alliance observes the following: “Average expenses per older adult in a skilled nursing facility can be four times greater than average expenditures for that individual receiving paid care in the community."
· Increase the amount of time Medicare beneficiaries can remain in skilled nursing facilities.
Not only are the aging Baby Boomers a large cohort; they are achieving great longevity. The number of those 85+ is expected to increase from 5 million in 2005 to 19.4 million by 2050. As this large cohort moves into their eighties, they will develop more chronic disease and require more assistance with activities of daily living and instrumental activities of daily living. The advanced age of residents in skilled nursing facilities demonstrates the correlation between attaining the highest ages and the need for long-term care. In 1999, 13% of residents in skilled nursing facilities were 65 to 74; 35% were 75 to 84; and 52% were 85 plus.
With the annual cost of a private room in a nursing facility averaging $75,190 in 2010 and rising, the financial impact of growing long-term care needs is daunting. The high cost of long-term care coupled with the longevity of the Baby Boomers leads experts to project that long-term care expenditures will almost exactly triple “from 115 billion in 1997 to $346 billion (adjusted for inflation) annually in 2040."
Currently, paying for long-term care comes from a variety of sources: family caregivers; out-of-pocket expenses paid by income, savings or other personal wealth; long-term care insurance for those who can afford it; minimally by Medicare; and most dramatically from Medicaid. The following percentages show funding sources for nursing home and residential care facilities in 2005 by decreasing percentages: 43% Medicaid, 24% resident out-of-pocket, 14% Medicare, 8% Veterans Administration, National Institutes of Health & Bureau of Indian Affairs combined, 6% private insurance, and 5% other.Before participating in the Medicaid, most Americans perceive it as a program for the financially destitute when the facts show that many older adults—including a significant portion of middle class Americans--move to Medicaid during their last years of life when other means for paying for long-term care are exhausted.
The transition from Medicare to Medicaid can be chaotic, emotionally taxing, and financially devastating. The Nurses Learning Network delineates the many stressors that ill people must manage, and moving from Medicare to Medicaid only complicates a devastating loss of well being.
Over the last twenty years, US health care has expanded the services between independent living and residency in skilled nursing facilities. With the advent of aging in place, home health care and assisted living, there are more gradual degrees of care. Some of the proposed changes in the Affordable Care Act do seek to expand custodial care under the Medicaid side, but changes that expand long-term care services on the Medicare side might help ease the psychological strain of enrolling in Medicaid and through co-pays may allow even a little relief to the federal governments budgets. Hopefully, changing policies can help make the rocky road of declining health a little smoother.
Long-term Care Is More Probable as We Age
Long-term Care Is More Probable as We Age