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Tag: Long-term care

  • Planning for long-term care; you’re more than likely to need it

    Planning for long-term care; you’re more than likely to need it

    Howard Gleckman reports for Forbes on why everyone 65 and older should expect to need long-term care. Most people do. And, there’s no way to know in advance whether you will or not. Here’s what you need to know to plan for long-term care.

    What proportion of older adults need long-term care? More than 60 percent of people need moderate or significant amounts of long-term care. Only one in five older adults do not need any long-term care. People between 65 and 70 who say they are in very good or excellent health are less likely to need it. About 30 percent of them will not need it.

    Will you need to pay for long-term care? About half of people over 65 will pay for some long-term care. Others depend entirely on family and friends.

    How long might you need long-term care? Overall, older adults need significant long-term care for an average of three years. But, if you need long-term care, you will typically need it for five years. More than one in five people need it for more than five years. That said, lots of people need it for less than a year.

    What types of care do people need? Typically people need help with activities of daily living, such as bathing, toileting and eating, for four years. And, many people need these supports for way more than four years.

    What will long-term care cost? The average cost is $140,000. And nearly one in five people will spend more than $250,000. But, half of people pay nothing.

    How much savings does a couple a need to cover health care costs? Fidelity estimates that, in addition to Medicare, a couple at 65 needs $300,000 in savings to cover medical bills in retirement. Wealthier, better educated older adults are less likely to need serious care and will need to spend less on care, on average.

    Is it worth buying long-term care insurance? It’s almost always better to set aside money to cover long-term care than to buy insurance. What the companies call level premiums tend to rise significantly over time, so a large portion of people who buy this insurance end up dropping it after paying in a bunch of money. Moreover, those who have it too often find that it does not cover a significant part of their costs. Insurance generally does not kick in for several months, which means you pay out of pocket for your care during that time. And, it generally has a cap, leaving you to pay for a big chunk of the costs.

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  • 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.

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  • PACE helps older adults stay in their community

    PACE helps older adults stay in their community

    The Program of All-inclusive Care for the Elderly (PACE) is a home and community-based program designed to keep older adults who are at risk for nursing home placement living in their community.  PACE is a partnership between a local sponsoring organization, and Medicare and Medicaid health insurance programs. To become a PACE “participant,” a person must be nursing home eligible. While a person can pay privately for services, most participants have Medicare, Medicaid, or both insurance programs.

    The PACE philosophy: PACE members are called “participants” because they are encouraged to participate in their care–decision making and active care–whenever possible.  The overarching goal of the PACE Model of Care is to keep people living in the community and out of institutional care.  While an individual does not need to visit the PACE Center, which offers adult day programs with wrap around health services, it promotes socialization and addresses common problems of isolation, loneliness, and boredom.

    Who can get PACE? Programs of All-Inclusive Care for the Elderly (PACE®) serve individuals who are age 55 or older, certified by their state to need nursing home care, able to live safely in the community at the time of enrollment and live in a PACE service area.

    How does PACE work? PACE works by providing care and services in the home, the community, and at the PACE center. It is team-based care that provides everything covered by Medicare and Medicaid if authorized by your health care team.  If your health care team decided you need care and services that Medicare and Medicaid doesn’t cover, PACE may still cover them.  The team provides comprehensive coordinated care and includes the PACE participant, physician, nurse, social worker, recreational specialist, rehabilitation specialists, and transportation specialists.

    Services: Delivering all needed medical and supportive services, a PACE program is able to provide the entire continuum of care and services to older adults with chronic care needs while maintaining their independence in their home for as long as possible. Services include the following:

    • adult day health care that offers nursing; physical, occupational and speech/language therapies; recreational therapies; meals; nutritional counseling; social work and personal care;
    • medical care provided by a PACE physician familiar with the history, needs and preferences of each participant;
    • home health care and personal care;
    • all necessary prescription and over-the-counter medications;
    • medical specialties, such as audiology, dentistry, optometry, and podiatry and speech therapy;
    • respite care; and
    • hospital and nursing home care when necessary.

    See more at: http://www.npaonline.org/policy-advocacy/value-pace#services

    Find a PACE program near you: Currently, there are 144 PACE organizations in 30 states serving 58,000 people. To find out if you or a loved one is eligible, and if there is a PACE program near you, visit www.pace4you.org or www.Medicaid.gov, or call your Medicaid office.

    Beware of for-profit PACE programs: Government audits find for-profit PACE program neglects patients, delays needed care and cancels critical care.

    Learn what to do to ensure safety at home for people aging in their communities. And, see how one new program is helping older adults remain at home with assistance from a handyman, occupational therapist and nurse. For those who like technology solutions, check out how sensors can offer peace of mind to caregivers.

    _________________________

    This post was originally published on March 2, 2016

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  • Coronavirus: The nursing home tragedy

    Coronavirus: The nursing home tragedy

    Jay Caspian Kang writes about Covid-19 and the nursing home tragedy in the US in an opinion piece for the New York Times. Nearly 200,000 nursing home and long-term care facility residents have died of Covid-19. After tapering off for a bit, Covid-19 deaths in long-term care facilities are increasing again.

    Nearly one in ten nursing home and long-term care facility residents have died of Covid-19. And, they continue to die. Congress and state lawmakers have taken precious little action to protect them. Indeed, former NYS governor Cuomo inexplicably required nursing homes to admit Covid-19 patients in stable condition post hospital discharge.

    All in, NYS nursing homes took in more than 9,000 residents with Covid. Rather than protecting residents, Governor Cuomo protected nursing home and hospital owners, through an order shielding them from liability for Covid-19 deaths in their facilities. Fortunately, that protection ended back in April 2021. The Cuomo administration also underreported the number of nursing home deaths.

    The nursing home industry is no longer about motherhood and apple pie. Most nursing homes are now owned by large corporations and are part of chains. Quality of care is a serious issue. Often, these nursing homes are understaffed.

    Kang says that nursing homes have always had the ability to contain the spread of the virus in their facilities. But, the for-profit nursing home owners fear losing money when they invest in containing the spread of Covid-19. Local governments, in sharp contrast, are not concerned with delivering profits to shareholders and can prioritize patient safety. Laguna Honda, run by the local government in California, had the staff necessary to keep people from dying and the willingness to respond to emerging issues swiftly, when necessary.

    Kang blames the for-profit nursing home industry “almost entirely” for all the needless nursing home Covid-19 deaths. They have not provided residents with the care they need. And lawmakers have sat quietly on the sidelines while this has happened.

    What’s beyond shocking is that, notwithstanding all these deaths–which some have called “murders”–nursing homes have raked in large profits. There does not appear to be the political will to keep nursing home owners from prioritizing profits, let alone to hold nursing home owners accountable for these deaths.

    It seems that it’s not worth it to lawmakers to act says Kang. The people running these nursing homes are powerful. And, we are an ageist society, with our representatives apparently willing to write off the death of the elderly as inconsequential.

    It’s time we passed laws that increased the rights of nursing home residents and made it costly for nursing home owners to behave negligently towards their residents. Moreover, state and local governments should be able to take control of for-profit nursing homes that are failing their residents, through eminent domain. Kang argues that there is no other solution that will lead nursing home owners to deliver the care people need.

    Currently, a large percentage of the money that Medicaid and Medicare allocate to nursing homes never gets allocated to the care and feeding of residents. Rather, it gets pocketed by the nursing home owners in one way or another. That’s why it is smart to avoid using for-profit chain nursing homes.

    One expert says that the nursing home industry is called the “Syndicate” because it is so corrupt. Whether we can overcome their money, their power, and their political ties is the question.

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  • Caregiving has become increasingly common, challenging and costly

    Caregiving has become increasingly common, challenging and costly

    We are an aging population. And, caring for older adults is costly. Not surprisingly, family caregiving is becoming increasingly common and challenging. It is unreasonable to assume that most older Americans have family and friends who will be able to care for them when they are unable to care for themselves and still make ends meet. Congress should step in to put in place systems and protections that ensure older adults get the care they need without overburdening family and friends.

    Anne Helen Petersen reports for Vox that nearly 42 million people in the US are volunteer caregivers for adults over 50. They represent almost 17 percent of the population. Many of these caregivers are so stretched that they are hard-pressed to make ends meet.

    Nearly three in ten (28 percent) caregivers are unable to save money. More than one in five caregivers are assuming more debt and/or have no short-term savings. More than one in ten of them cannot pay for essentials such as rent and food.

    More than one in four caregivers are young, either millennials or Gen Z. Increasingly, they provide care in their homes.

    The workload for caregivers has grown in just ten years in part because people are living longer. Caregiving involves cooking and cleaning as well as medication management, bathing and providing transportation. Only three in ten caregivers pay others to help with caregiving.

    Caregiving takes a huge toll on people’s mental and physical health as well as finances. And, there’s no system in place to help caregivers. Most people don’t even think of themselves as caregivers. They think of their work as helping out their loved ones.

    Family caregivers are effectively invisible, which makes their situation all the harder. They often step in to help because they see themselves as having no choice. AARP believes more than half of them find themselves in that situation. Paid caregiving is unaffordable. Caregiver coordination is also taxing.

    What is to be done? One elder care expert believes that the federal government should at the very least manage a web site that details caregiver resources by state and community. More money should be available for Area Agencies on Aging, as well. These “Triple As” provide resources to older adults.

    What is really needed is a comprehensive federal long-term care program. The budget reconciliation bill allocates money for community and home-based services for people with Medicaid but not for people with Medicare. That is a beginning, but not enough.

    We also need to improve nursing home care and pay caregivers better wages and benefits for the work they perform.

    Here’s more from Just Care:

  • Paid caregiving should be valued as health care

    Paid caregiving should be valued as health care

    Lynn Hallarman, MD, former director of palliative care at Stony Brook University Hospital, writes for The New York Times about the value of paid caregiving. What’s most important for aging Americans is to have a caregiver who knows how to keep them safe and properly cared for. And, that should be valued as health care.

    Many children of aging parents cannot be there with their parents towards the end of their lives. Consequently, nearly half of people turning 65 today will need a paid caregiver to remain in their homes and communities, to live independently and with dignity. But, the cost is prohibitive for many. It can easily be $4,500 a month.

    Health insurance rarely covers caregiving services. Long-term care insurance tends to be extremely costly and usually only covers a portion of an individual’s home care. There’s also almost always a waiting period that can easily be three months or longer. So, insurance is generally not worth the investment.

    What’s as concerning is that paid caregivers tend not to earn a living wage; they also need better benefits and better training. We need more paid caregivers to provide direct care to older adults so that they can age in place.

    Today, states are left to bear a lot of the burden of providing home and community-based care to their Medicaid population. Hallarman believes a national partnership is needed. Funding for community-based services for older adults is critical.

    Older people in their last years of life tend to need a wide range of direct-care services. They might need help preparing meals, bathing, moving from one place to another, going to the toilet. It is hard and tiring work. It can also be extremely physically demanding.

    Medicare covers hospice services for people deemed to have less than six months to live, who opt for comfort care. Hospice services are generally not provided 24 hours a day. But, Medicare hospice covers care from a home health aide and others to ensure that patients are pain-free and living comfortably.

    A good caregiver is going to take note of increasing confusion in an older person, pain and whether and what the person is eating. The caregiver should be clipping toenails and checking for bedsores. We need to value caregivers for the extraordinarily challenging and important health care work they perform.

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  • 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:

  • Government-administered long-term care insurance is long overdue

    Government-administered long-term care insurance is long overdue

    Since the start of the novel coronavirus pandemic, more than 46,000 people have died in nursing homes.  The private health care market is failing, and government-administered long-term care insurance, ensuring government oversight, is long overdue.

    Alexander Sammon makes the case in the American Prospect that the private long-term care insurance market has failed Americans more than any other piece of the health insurance market. Long-term care is the term used to describe an array services and assistance provided to older adults and people with disabilities. It includes help with activities of daily living such as bathing, feeding and toiletting, as well as nursing and therapy services.

    For sure, the number of deaths of older adults in long-term care facilities are easy to track and horrifying. Though, without good data and knowing that out-of-pocket costs keep people with complex conditions from getting medical and hospital care, it is not at all clear that the number of deaths of working people with serious illnesses and injuries stemming from their private health insurance is not equally chilling.

    What the long-term care story reveals is how a for-profit health care market endangers people’s lives by putting profits first and cannot be relied upon to guarantee our health. More than one in ten long-term care residents are no longer with us, in large part because long-term care facilities were not prepared to care for them.

    At some point in your life, there is a good chance that you will need long-term care. Seven in ten people 65 and older require long-term care. Most people rely on family and friends or Medicaid for long-term care. Only about three percent of Americans have long-term care insurance; it is expensive, often not available to people with pre-existing conditions, and generally not worth the cost, delivering little bang for your buck.

    Because the cost of long-term care is so high, private insurers are hard-pressed to profit from selling coverage and the market has shrunk considerably.

    When it was being drafted, the Affordable Care Act included government coverage for long-term care. But, it was designed as a voluntary program with high costs. And, it would not have paid for itself. So, it was dropped from the law before enactment.

    Sammon reports that Americans do not appreciate how likely it is that they will need long-term care. And, many also do not know that Medicare only covers a limited set of long-term care services: up to 100 days of care in a skilled nursing facility if certain qualifying criteria are met, some home care for people for whom leaving home is extraordinarily difficult and who need skilled nursing or therapy services, and durable medical equipment.

    The cost of long-term care keeps rising. It costs seven times more in 2015 ($225 billion) than it did in 2000 ($30 billion). The private market is not up to the task of providing good coverage.

    There are smart ways to provide everyone long-term care coverage through social insurance. Washington state enacted a social insurance program, imposing a small payroll tax on workers’ salaries. It will pay out $100 a day for up to a year of in-home care. Hawaii did something similar. It’s time that the federal government stepped in and offered similar or better coverage to everyone in the nation through social insurance.

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  • Coronavirus: It will be challenging for many older adults to vote

    Coronavirus: It will be challenging for many older adults to vote

    It seems inconceivable in the year 2020 that everyone in this country eligible to vote should not be able to do so easily. With technology as sophisticated as it is, voting should be a simple protected click of a button. Instead, barriers to voting for large portions of the population remain huge; Kaiser Health News reports that many older adults living in nursing and other living facilities may not be able to vote this November. 

    The novel coronavirus is keeping family members from visiting with their loved ones in nursing homes and other group home settings. That will make it harder for older adults to vote. Family members are often responsible for helping their older loved ones complete voting ballots. Moreover, COVID-19 will also keep group homes from establishing on-site voting precincts.

    In some group homes, volunteers are assisting residents with voting by mail. But, this is not standard. And, it is generally not required. So, it seems more than likely that a smaller portion of older adults will vote in the upcoming election.

    States can step in to require facilities to help older residents with voting. California’s Department of Public Health is telling facilities housing older adults that they must help their residents with voting. But, a lot of these facilities are short-staffed. And, even when there are staff, the staff might worry about being seen as influencing residents’ votes. Moreover, some states only permit bipartisan assistance teams to help people to vote.

    Typically, more than 70 percent of older adults vote, as compared with less than half of young people between 18 and 29 years. old. Usually, there also are lots of voluntary organizations that assist older people with voting. In addition, candidates typically campaign at nursing homes and assisted living facilities. But, not during this pandemic.

    In the past, congregate living facilities would either have voting booths on site or bus their members to a voting site. This time round, older adults might need to request an absentee ballot in order to vote.

    If you or someone you love is not getting needed assistance to vote, contact the state’s long-term care ombudsman. Every state has one. The ombudsman provides free help and can work with the state’s Department of Public Health to see what help is available.

    Here’s more from Just Care:

  • Coronavirus: Strike teams step in to help nursing home residents and staff

    Coronavirus: Strike teams step in to help nursing home residents and staff

    Nursing homes and other residential facilities have been hard hit by the novel coronavirus, with residents and staff easily representing 40 percent of lives lost in the US. What do you do when there’s a natural disaster of this sort? The New York Times reports that  some counties are sending in strike teams–medical workers and other emergency responders–to  help nursing homes and other residential care centers and provide aid to residents.

    Strike teams are usually made up of eight to 10 people from local health departments, private businesses, nonprofits and emergency response agencies. They bring their expertise and assistance to the nursing home disaster at the request of a facility. For example, county nurses and doctors may be called upon to step in for nursing home staff who become sick. They might test staff and residents for COVID-19 and provide care to residents. By so doing, they can help keep these residents from needing to be hospitalized.

    In Henderson County, NC, a rescue squad of volunteer paramedics set up tents where staff could take off their personal protective equipment. They taught staff important safety protocols. Residents’ families and staff received emotional support from chaplains and mental health therapists. And, someone with PR expertise was charged with helping family members understand the plight of residents in the facility.

    The goal is to slow the spread of the virus through better coordination of care. A strike team response is often used when there is a hurricane or other natural disaster. The inability of many nursing homes to contain the spread of the novel coronavirus within their facilities is just that, a natural disaster. It’s far simpler to help people on site with a team that knows how to manage the emergency than to remove people from the site.

    States, including Texas, Massachusetts and New Jersey, have taken on some emergency response work at nursing homes and other long-term care facilities. A bi-partisan bill in Congress would appropriate money for these states to continue this work. Though, it’s not clear whether it will be enacted into law.

    Now, more local agencies are taking emergency response measures to help the thousands of understaffed and under-resourced nursing homes and assisted living facilities in small communities across the country.

    While there is no data yet available on the benefits of the strike team approach, experts say it makes sense and, anecdotally, people say it is working.

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