By Cyril Tuohy
Initial reports about the state of long-term care delivery in the U.S. paint a picture of a fractured, overlapping hodgepodge of services unevenly administered by states through federal insurance programs.
In addition, much of the long-term care that gets to the elderly is unplanned, delivered with little structure and left to health aides laboring in the trenches for minimum wage, according to long-term care experts.
“Simply put, services for frail, elder persons individually and as a group, need to be planned far better than they are currently — which, in many instances, is that there is no planning at all,” said Dr. Joanne Lynn, director of the Center for Elder Care and Advanced Illness with the Altarum Institute, a health care policy think tank.
Lynn was among a dozen long-term care medical and policy experts who have testified over the past month about the state of long-term care before the Commission on Long-Term Care. The 15-member bipartisan body, created under the American Taxpayer Relief Act of 2012, or the so-called “fiscal cliff” bill, is expected to spend the rest of the summer hearing from more experts before making recommendations to Congress.
While the facts of the state of long-term care in the U.S. may come as a surprise to lawmakers serving on the panel, for experts in the field, the “outrageous” neglect of elderly and frail Americans has gone on for too long. Among the charts, tables and graphs showing future government deficits and financing mechanisms for long-term care, Lynn has provided the most compelling and unsettling testimony so far about the delivery of long-term care.
“For a 92-year-old man to show up at an emergency room where no one knows his situation, preferences or plans indicates a thoughtless lack of planning,” Lynn said. “For that same man to show up at his physician’s office where no one knows his situation, preferences or plans is thoroughly outrageous. Yet, that’s the standard. We don’t even have a way to put a comprehensive care plan into our evolving electronic health record system.”
Doctors can order any treatment or test for a frail elderly patient, “with virtually no regard to cost,” she also said, yet, finding a home health aide to perform simple tasks like bathing people, paying simple bills or providing them with a nutritious meal seems so much more difficult.
Further shortcomings of the provider side of the long-term care delivery equation were provided earlier this month by Carol Regan, government affairs director at PHI, a company charged with recruiting, training and supervising workers who provide long-term care.
Five years after the Institute of Medicine delivered recommendations to Congress concerning the direct-care workforce, little has changed and, she said, “there remains a glaring absence of coordinated federal policy leadership directed at augmenting and improving the nation’s direct-care workforce.“
Thousands of direct-care workers who cater to the elderly living in their homes, in residential care facilities or nursing care facilities work for “near-poverty wages,” lack health insurance of their own and “often rely on public assistance to make ends meet,” Regan also said.
The urgency of addressing the challenges of long-term care increased markedly after 2011, when the leading edge of the baby boom generation began turning 65. That year, baby boomers who were born in 1946 began to retire in droves. Now, as many as 10,000 boomers are retiring every day, and will be doing so for the next two decades.
Most retirees don’t need long-term care at first. As they age, they need more help with daily living activities such as eating, bathing and using the bathroom. For those who fall victim to Alzheimer’s disease or dementia, the demand for and cost of long-term care skyrockets.
The projected size of the long-term care population needing help with a least one activity of daily living, or because of a cognitive impairment or mental disability, is expected to rise from 9.8 million people in 2010 to 16.5 million in 2050, an increase of 70 percent, said Anne Tumlinson, senior vice president of the consulting firm Avalere Health.
At the same time, the number of Americans 85 years old or older is expected to rise from 1.8 percent of the total population in 2010 to 4.3 percent in 2050, an increase of 3.5 percentage points, by which time Americans 65 years and older will make up 20.2 percent of all Americans, Tumlinson said.
Kirsten J. Colello, a specialist in health and aging policy with the Congressional Research Service, said total spending in 2011 on long-term care services came to $317.1 billion, representing almost 14 percent of the $2.3 trillion spent on personal health expenditures in the U.S.
The bulk of that, $230.9 billion or 72.8 percent, came from public sources, namely Medicaid and Medicare. The remaining $86.2 billion came from out-of-pocket and private sources including long-term care insurance, she said.
Cyril Tuohy is a writer based in Pennsylvania. He has covered the financial services industry for more than 15 years. He can be reached at [email protected].
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