JustCare

Category: Long-term care

  • If you need long-term care services, how will you get them?

    If you need long-term care services, how will you get them?

    The majority of older adults will need long-term care services at some point. But, caregiving costs for older adults are super high, stemming from significant labor and facility costs, along with high demand. If you need long-term care services, how will you get them?

    More and more people are looking for adult day care, assisted living facility care and nursing home care. For many of them, relying on volunteer caregivers, such as friends and family, is not possible. But, the cost of paid care is prohibitive, swallowing up years of savings quicly. Caregiving costs increased more than 20 percent between 2012 and 2019 and continue to rise.

    Medicare does not pay for long-term care services. At best, Medicare will cover 100 days in a rehab facility or nursing home for people who need daily skilled nursing or therapy services. And, most Medicare Advantage plans inappropriately deny coverage for rehab and nursing care beyond a few days.

    But, a stay in a rehab or nursing facility can cost thousands of dollars if you have to pay out-of-pocket. The average cost of a nursing home stay is now more than $9,000 a month. The average cost of a stay in an assisted living facility is more than $4,500 a month.

    Caregiving costs are a lot higher in some states than others. In Massachusetts, average costs for a nursing home stay can be more than $15,000 a month. An assisted living facility stay can cost well over $8,000 a month.

    More than four in five households with someone over 65 need some type of care. Almost a quarter of them have significant care needs, including round the clock care. Almost two in five need help, though not round the clock. Only about one in five of them need minimal care, such as help getting groceries and cooking.

    Here’s more from Just Care:

  • Rents soar for older adults in private-equity owned senior housing

    Rents soar for older adults in private-equity owned senior housing

    Rebecca Burns reports for The Lever on the plight of older adults living in private-equity-owned senior housing. The bottom line: Watch out, private equity is buying up senior housing and hiking up rents; older adults are at risk of eviction.

    Background: Older adults need affordable places to live, where they can age in communities with strong support systems. There are some good options, but many options are unaffordable. Seeing an opportunity for big profits, private equity has stepped in to the senior housing market.

    But, be it senior housing or nursing home care, private equity is watching out for its investors first and foremost, not older adults. In the nursing home arena, private equity firms have lost business as a result of a sharp rise in Covid-19 deaths. To maximize profits, they cut staff. Stories abound of residents not being cared for.  The federal government has not addressed this crisis yet. President Joe Biden said in his State of the Union address last year that this type of predatory behavior “ends on my watch.”

    Wall Street firms have still done well in the nursing home arena, while older adults have struggled. In private-equity-owned nursing homes, at least one group of researchers has found that resident death rates were up by 10 percent. The private equity firms reduce staffing to increase profits. One study found a 50 percent increase in use of anti-psychotic medicines at private-equity owned nursing homes; it was the owners’ way of compensating for fewer staff.

    “Wellness” housing for seniors: Many Wall Street players have moved into owning and renting out “wellness” housing units to older adults. Wellness housing does not require nursing staff. Wellness housing is different from assisted living facilities and does not provide long-term care services. Investors count on older adults to be able to pay the rent with the proceeds they received from selling their homes.

    Welltower is a real estate investment trust or (REIT) that owns thousands of units of housing for older adults, as well as 2,000 health care facilities. Welltower and other private-equity-backed firms see big dollar signs in the senior housing and health care markets.

    One emerging crisis for people living in private-equity owned senior housing is big unexpected rent hikes. Welltower, for example, is raising rents on its housing far more than other landlords to increase profits. It can do so because the supply of affordable housing for older adults is very limited. And, Welltower owns a larger amount of moderately priced housing for older adults than any other company.

    Companies like Welltower lure older adults to move into them with the promise of small rent increases, community and a vast array of amenities. Still, one resident whom The Lever profiled arrived at his unit only to find that even basic safety features were not in place. Soon after, residents were told that their rents were rising as much as 39 percent, more than four times the increases in adjacent communities.

    The federal government helps Welltower to profit handsomely. As a REIT, Welltower benefits from federal tax-exempt status. It gets a big tax subsidy. The goal of the tax subsidy was to incentivize investments that delivered positive outcomes. Instead it is subsidizing investments that make housing unaffordable for older adults.

    The federal government also gave Welltower $65 million in Covid funds. The money was intended for health care providers. What is the federal government doing to help older adults who need affordable housing?

    Here’s more from Just Care:

  • Most middle-income older adults will not be able to afford long-term care

    Most middle-income older adults will not be able to afford long-term care

    According to a new study by NORC at the University of Chicago, ten years from now, 11.5 million of the 16 million middle-income older adults might not be able to afford the long-term care they need. And, Medicaid is unlikely to help them. It’s wise to plan ahead in case Congress does not step in.

    How will middle-income older Americans afford their housing and care needs? With annual income under $65,000, they will not have enough money to cover these basic necessities. More than half of them, 6.1 million, could not afford these key needs even if they were to sell their homes. More than one in five of them are people of color.

    Long-term care affordability will be especially critical for the 9.5 million of them who live alone—never married,  widowed or divorced. More than 4.4 million of them do not have children living within daily caregiving distance. Without a spouse or kids to provide voluntary caregiving, middle-income older adults are at serious risk.

    People tend to experience multiple health issues by the age of 75. Slightly more than half of them are projected to have at least three chronic conditions. Slightly more than half of them are also projected to have difficulty moving.

    Health conditions and mobility limitations tend to increase as people age, making the need for log-term care all the greater.

    “We need a combined public and private response to address the long-term care needs of the Forgotten Middle,” says Caroline Pearson, senior Vice President of NORC, lead author of this study. “Policymakers should examine healthcare and housing policies that can extend funding for personal care and caregiving support to avoid middle-income seniors spending down to nursing homes.”

    Here’s more from Just Care:

  • Washington State delays plans to give residents a long-term care benefit

    Washington State delays plans to give residents a long-term care benefit

    If the US does not already have a long-term care crisis, and there’s a good argument we do, it’s hard to imagine we won’t face a crisis shortly. As the cohort of older Americans grows, so does the need for long-term care, and the cost is likely to be prohibitive for most. While Congress is currently sitting on its hands, Washington State passed a state-based long-term care benefit, but its launch is now delayed until 2023, with coverage not beginning until 2026.

    Washington is the first state to pass a law offering residents long-term care coverage, albeit quite limited in scope. The benefit covers up to $36,500 in long-term care costs in an individual’s lifetime. It is designed to pay for aide services as well as home modifications and other needs, or 2o hours a week of home care for one year. It could be a huge help for many, and still not enough help for some.

    The Washington long-term care benefit, WA Cares Fund, has been delayed to July 2026. To cover the costs of WA Cares Fund, 3.1 million workers in Washington are expected to pay a small payroll contribution beginning in July 2023, much like they do with Medicare and Social Security. Annual costs will be about $302 for someone earning $52,000 or 0.58 percent of earned income. Costs will be far higher for wealthier individuals. You must pay in for at least three years to qualify for the benefit.

    Most people don’t realize that Medicare does not cover long-term care. It covers no more than 100 days in a skilled nursing facility for people who have been hospitalized for at least three days and who need daily skilled nursing or therapy services. It also covers some home health care services–between 20 and 30 or so hours a week–for people who are homebound and need skilled therapy or nursing services on an intermittent basis.

    Medicaid does cover long-term care. It is an invaluable benefit. But, in order to get Medicaid, your income and assets need to be extremely low. Thankfully, in many states, if your income and assets are above the eligibility level, your health care expenses need to bring your income and assets down to the eligibility level before Medicaid will kick in.

    Can the Washington state long-term care benefit work? It’s hard to know. With more than six in ten people needing long-term care at some time in their lives, it will take a lot of money to cover the cost of the benefit. And, many Washington state residents appear to be worried about paying in and not being able to get back what they invested.

    Nearly 500,000 Washington state residents have turned to buying private long-term care insurance as an alternative that exempts them from the requirement of paying into the state fund. Private long-term care insurance has always been a gamble, with premiums able to double out of nowhere and the benefit often more limited than people realize.

    Congress needs to step in to avert a long-term care tsunami. The population of people over 85 and the population of people with dementia are expected to double by 2042. The cost of long-term care is only rising. Countless people will die needlessly, in isolation, if nothing is done.

    Here’s more from Just Care:

  • Our nursing home crisis is only worsening; who cares?

    Our nursing home crisis is only worsening; who cares?

    Jay Caspian King writes for the New York Times about our worsening nursing home crisis. For decades now, big corporations and private equity firms have been buying up nursing homes, collecting money from Medicare and Medicaid to provide care, and failing their residents. Will Congress act to protect vulnerable older Americans and people with disabilities?

    Early on in the pandemic, the media did a good job of highlighting the nursing home crisis. Thousands of nursing home residents died needlessly. The facilities were understaffed and doing a poor job of caring for their residents. But, the attention did nothing to address the problem.

    Instead of fixing the nursing home crisis, many politicians tried to bury it. The National Academy of Sciences issued a report recommending major industry reforms, such as smaller nursing homes, better pay and training for workers. Right now, some nursing homes have 100 percent turnover, staff are so underpaid.

    The Biden administration also drew up a plan to improve nursing home conditions and made note of private equity’s mounting investment in nursing homes–up to $100 billion in 2018.

    But reports and plans recommending specific reforms to the industry have been issued for the last several decades and little has been done to improve conditions. It costs money to ensure nursing homes have more and better paid staff. It costs money to oversee nursing homes and ensure that when they violate the law, they are penalized appropriately.

    There are a lot of regulations in place. But, even when major violations are identified, nursing home are allowed to continue to operate. Change is not possible without an overhaul of chain nursing homes and other for-profit nursing homes.

    We need more transparency as to where government money is going, how nursing homes are spending the money they receive from government. People need to know how much of that money is being put towards patient care. We cannot continue to let nursing home owners profit without being held to account for the care they provide residents.

    Here’s more from Just Care:

  • US House passes Build Back Better Act

    US House passes Build Back Better Act

    Last week, the US House of Representatives passed the Build Back Better Act, legislation designed to improve the lives of tens of millions of Americans. The Senate still needs to pass the bill before President Biden can sign it into law. In all likelihood, the Senate will water it down some. But, as it stands, here’s what it will do to reduce the cost of health care for people with Medicare and all Americans:

    1. It strengthens Medicaid to cover more home and community-based services. Millions of people with Medicare who also have Medicaid can benefit from this provision. Medicare only covers home care in limited situations, for people who need skilled nursing or therapy services on an intermittent basis.
    2. It adds a hearing benefit to Medicare. If passed, Medicare would cover audiology services and hearing aids.
    3. It allows Medicare to negotiate the price of some popular high-cost prescription drugs that have been on the market for at least nine years. Over time, Medicare would negotiate the price of up to 60 prescription drugs.
    4. It caps out-of-pocket costs in Medicare Part D, outpatient prescription drug coverage, at $2,000 a year.
    5. It caps the coinsurance cost of insulin for people with Medicare and people with private insurance at $35 a month.
    6. It limits the amount pharmaceutical companies can raise prices on their drugs from one year to the next to no more than the rate of inflation.
    7. It helps low-income people in the 12 states that have not expanded Medicaid access health insurance coverage through their state health insurance exchanges at low or minimal cost.

    Here’s more from Just Care:

  • Grandfamily housing: A means to support multigenerational caregiving

    Grandfamily housing: A means to support multigenerational caregiving

    Grandparents are increasingly caregiving for grandchildren and other young relatives. Carly Stern reports for The New York Times on a growing trend of multigenerational caregiving and housing that sometimes goes with it. Grandfamily housing supports multigenerational caregiving; we need more of it.

    Today there are some 2.3 million grandparents caring for children. Some of them are lucky to find affordable multigenerational housing options in new communities, such as Bridge Meadows in Oregon, the Fiddlers Annex in Smithville, Tennessee, the Grandparent Family Apartments in the Bronx. NY, and Plaza West, in Washington, D.C.

    These new multigenerational communities help older adults with low incomes living with younger relatives. They provide mental health and other social supports.

    Grandfamily housing is quite new. There’s not a whole lot of data available on them. We know only that multigenerational housing is in very short supply. There are about 2.7 million kids being raised in grandfamilies and only 19 known grandfamily housing communities. Public-private partnerships fund most of these initiatives.

    Only about one third of grandparents in grandfamilies get housing assistance of any kind. It is particularly hard for grandparents to get support if they are not the legal guardians of the children they are caring for. Without assistance, it is challenging for many of them. One in four are raising children with disabilities.

    As it is, housing costs can be exorbitant and eat into a sizable portion of people’s income. More than ten million older adults spend more than 30 percent of their income on housing. Many grandparents in grandfamilies cannot live in senior care facilities because these facilities do not allow kids. Their need for housing and social supports is profound.

    Congress has introduced legislation, The Grandfamily Housing Act, that would expand the number of grandfamily communities and would pay for renovations to help ensure grandfamilies live safely.

    Here’s more from Just Care:

  • Coronavirus: More home and community-based services needed

    Coronavirus: More home and community-based services needed

    For all the tragedy that Covid-19 has wreaked on this nation, there are a few silver linings. COVID-19 has cast a spotlight on the failings of nursing homes and the need for more home and community-based services and more affordable services so that older and disabled adults can age in place. The New York Times reports that many people today do not have the option to remain in their homes as they age because it can be so costly.

    People living in nursing homes and other adult care facilities during this pandemic have suffered mightily. As of now, about 181,000 have died. They represent one in three of all COVID-19 deaths, according to the Kaiser Family Foundation.

    What can communities do to help people and keep them from having to be institutionalized? Fewer and fewer people would choose institutionalization if they could remain in their homes. In the last three months of 2020, one in four nursing home beds were unfilled.

    Age-friendly communities offer a range of services to older people who need help caring for themselves. They might provide affordable age-friendly housing, good transportation and care services. Age-friendly housing generally provides living space on one floor without steps, walk-in showers, and hallways and doors that can accommodate wheelchairs.

    In some cases, apartment buildings can offer an array of services beyond shelter, such as grocery stores and pharmacies. In that way, older adults can have several community essentials at their fingertips, without having to leave the building. This set-up could benefit a lot of older adults.

    But, as people move into their 80’s and 90’s, they often need long-term care services as well. Medicare does not cover long-term care. At most, it covers 100 days in a skilled nursing facility, and that’s only if you’ve been hospitalized for at least three days prior to admission and need daily skilled services.

    Medicaid covers long-term nursing home care. But, it often does not cover home and community-based care. A little more than half of its spending for long-term services and supports covers home and community-based care. More than 40 percent goes to nursing-home care.

    What’s worse, even people who qualify for Medicaid might not get it. In many states, there’s a long Medicaid waitlist. Forty-one states limit Medicaid enrollment. Right now, 820,000 Americans are on a waiting list. On average, they wait more than three years. Fortunately, the American Rescue Act gives more money to states to expand Medicaid services. And, Biden’s new infrastructure proposal includes $400 billion more for home and community-based care.

    Here’s more from Just Care:

  • President Biden proposes funding for long-term care infrastructure

    President Biden proposes funding for long-term care infrastructure

    John Nichols reports for The Nation on President Joe Biden’s American Jobs Plan, which is designed to address America’s failing infrastructure. Billions would go to bridges, roads and other public transportation engines. Wisely, billions would also go to fund America’s failing long-term care infrastructure, supporting at home and community care.

    Joe Biden’s plan calls for Congress to allocate $400 billion to ensure the availability of more affordable home and community-based care. The goal is to foster a more humane life for hundreds of thousands of Americans. In the process, it will create hundreds of thousands more jobs for caregivers, along with better wages and benefits. Today, one in six care workers live in poverty.

    Right now, about four million people turn 65 every year. As they age, they often need help caring for themselves. But, the US offers precious little in the way of long-term supports and services, except for some people on Medicaid–and often people cannot access that care because they don’t meet the strict eligibility criteria or their state has a long waiting list. Medicare pays for only a small amount of nursing home care and home care, and only in limited situations.

    President Biden’s team recognizes that “increasing the pay of direct care workers greatly enhances workers’ financial security, improves productivity, and increases the quality of care offered.”

    Specifically, Biden’s plan will expand access to home and community-based services under Medicaid. It will also pay for caregiving jobs with benefits, and will enable collective bargaining and union membership for workers. The question is will Congress support it?

    If all goes well, the Biden administration will build on these benefits. Older adults and people with disabilities who do not qualify for Medicaid also need help paying for at home and community-based care. And, families need paid family and medical leave. We have a long way to go to build a more humane society.

    Here’s more from Just Care:

  • Don’t trust Medicare nursing home star ratings

    Don’t trust Medicare nursing home star ratings

    Two and a half years ago, I warned people not to be misled by Medicare five-star nursing home ratings. Unfortunately, you still can’t trust these nursing home star ratings. If Medicare can’t ensure that all nursing homes deliver high quality care, at the very least it needs to rate them appropriately.

    The New York Times reports that the nursing home gaming of Medicare star ratings continues. The star-rating system is broken. More than two-thirds of the 3,500 nursing homes with five-star ratings have been cited for problems with infection control and patient abuse.

    Five-star nursing home ratings continue to be misleading. Of the 130,000 nursing home residents who have died of COVID-19, those in five-star nursing homes were as likely to die as those in one-star nursing homes. Five-star nursing homes often fail in-person inspections.

    The New York Times reports that California is suing Brookdale Senior Living, the nation’s largest nursing home chain, for filing false information about its services to Medicare, with the goal of getting a high star-rating. Part of the problem is that Medicare relies mostly on unaudited and self-reported data to determine the number of stars it gives a nursing home.

    Naturally, nursing homes have an incentive to game the system. A five-star rating can lure more people to them and boost profits. Brookdale is alleged to have cooked its payroll books so that CMS would see high staffing levels at its nursing homes, Brookdale also allegedly asked its staff to misrepresent the amount of care their patients receive.

    Here’s more from Just Care: