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In the field of gerontology, long-term care planning is a very hot topic. I can’t pick up an aging newspaper or journal without some mention of this issue. That is not to say I am surprised by the attention it gets. One of the most startling facts I learned in class was that unpaid caregivers provide services valued at $450 billion per year!
Long-term care (LTC) is an essential expense and while many dream of a healthy retirement filled with vacations and relaxation, this is far from the reality. Most people will grow old and frail and need LTC during their retirement years. Unfortunately, most are not planning for it and the government is cutting back on affordable options that could help. Though Americans are not planning for LTC, they are worried. A California poll on this issue found that two-thirds of people don’t know how they will be able to afford LTC. They are just as concerned about this expense as the cost of their future healthcare. So if people are aware of the problem, why the inaction? Perhaps it’s because they don’t know where to begin. What affordable options do they have so they can age with dignity and independence, living how they want in the place they choose?
Information to Consider:
What is Long-Term Care = when you are not able to complete personal care or other daily activities on your own. This is most often the result of a chronic illness or disability. In some cases, the illness or disability may include cognitive impairment.
How Much Care Do You Need = about two-thirds of today’s elders will need LTC support. Women need care longer (on average 3.7 years) than men (on average 2.2 years), mostly because women typically live longer.
How Do You Plan and Pay = the National Care Planning Council has a detailed guide to planning for your LTC needs. This 7 step plan involves understanding the care settings and available government programs, who you should call on for help, how you can pay for services, and how you can protect your assets. More information about the public and private sources for funding LTC can be found on the Department of Health and Human Services website.
It may be daunting to see all the steps and options to consider. I’m asking you to start thinking about this decades before it’s needed! Perhaps having the following conversations is a better starting point for some of us. Begin thinking about LTC and your own life. Then when you do your research, you’ll be aware of your personal needs and desires.
(1) Talk with your spouse, adult children, friends, or siblings about whether they might care for you if I became ill or disabled. Tell them how you feel about relying on their help.
(2) Ask your family doctor whether you might be at higher risk for needing long-term care someday based on your medical and family history or lifestyle risk factors.
(3) Talk with a financial planner, insurance agent, attorney, or other financial advisor about how you would pay for long-term care services if you need them.
The 2011 OWL Mother’s Day report starts with a very strong statement: “Health care for all is a women’s issue…” Why would this be? Men also need and use our health system. Yet, the case is made for how women’s lives are affected by health care coverage or a lack there of. Women play a large role in managing care for sick family members, most often providing this care themselves. Widows can often be left impoverished if their husbands’ chronic illnesses dwindled savings accounts and assets. In late life, women find themselves 60% more likely to need help with basic daily activities (i.e. eating, dressing, bathing) compared to men. This paints a picture in our minds: Grandma spent her 60’s and 70’s caring for grandpa. He had heart problems and diabetes but she made sure he took his medications, got to his appointments, and was cared for till the end. Now in her 80’s, grandma finds herself sick, poor and alone in a big, empty house. Since women’s life expectancy continues to exceed that of men’s, this story is all too familiar.
“After a lifetime of caring for others, older women often need affordable care but find that the costs are high and their options are severely limited.” I’ve described to you a common late-life situation for women. Let’s keep this image in our minds as we discuss how the Affordable Care Act (ACA) aims to support Americans as they age. People, like grandma, find themselves skipping preventative services because Medicare requires them to pay a 20% co-payment. This cost is found to be a disincentive for approximately half of Medicare beneficiaries who do not use preventative services available to them. Grandma lives on a fixed income of $1,000/month from Social Security (the average benefit is $1,177) and this means that paying a $30 co-pay to see her doctor gives her $30 less for grocery shopping that month. She isn’t feeling sick, so she prefers to spend the money on food. This begs the question: Should she have to make that choice?
The good news is changes to our health care system are happening over the next few years and should support people in old age. Below I’ve highlighted some of the changes but please read the full report or see this great summary of the Health Reform Law from the Kaiser Family Foundation for more details.
Health Insurance Reforms
- Medicaid will be expanded to cover 16 million Americans (all legal residents up to 133% of the federal poverty level will be eligible)
- Retroactive cancelling of insurance because of accidents or sickness, denying coverage because of pre-existing conditions, and basing premiums on health status, gender and genetics will all be prohibited
- Insurance companies must devote at least 80 – 85% of premium dollars received to medical benefits and quality improvement and they must provide justifications for any excessive rate increases, making this information available to consumers
- People who reach the “donut hole” on prescription drug coverage will get a large discount on drugs and biologics and this discount will grow each subsequent year. The hole will be closed in 2020
- Beneficiaries will receive a free annual exam, free flu and pneumonia shots, and any covered service that is given a grade A or B by the U.S. Preventive Services Task Force must be provided at no cost
- Medicare payments will be reduced for hospitals that have high HAC rates (hospital-acquired conditions) and incentives will be provided to hospitals that improve their transitional care and partner with community services to reduce readmission rates
- The Community Living Assistance Services and Support (CLASS) Act will provide a voluntary long-term care insurance program available to all working Americans. When an individual becomes eligible and needs long-term care services an average cash benefit of $50/day will be given to help them pay. Beneficiaries have control over their own care, so this includes paying family or friends who provide help at home.
- Home and Community Based Services (HCBS) aim to provide a network of services within state and local areas to meet the needs of elders aging in place. A new protection called under HCBS will attempt to prevent “spousal improverishment” by only counting the ill spouse’s income when determining eligibility.
- Nursing home care will be improved as the ACA aims to make the system, procedures, staffing and care more transparent and regulated. The Elder Justice Act is a part of this, in an attempt to identify and prevent elder abuse.
In the United States everyday people are providing 85% of needed long-term care for their family members and friends. These roles are generally unpaid and at the expense of their own careers, health, and well-being. Rather than creating a health system that works, we have created a system that to a large extent depends on informal caregivers yet still costs us 17% of GDP. The ACA is not a perfect system and will not be fully up and running for a few years. Still, it is a step in the right direction and will expand coverage to 95% of the population and support those who care for the people they love.
If you find yourself bombarded with mixed messages or feeling confused about the new health care changes, I encourage you to at minimum read the OWL Mother’s Day report’s appendix. Here the authors address a number of major myths about the Affordable Care Act and answer some common questions about the policies and coverage.
While on a recent phone conversation with my best friend we got to talking about her parents and their (in her opinion) impulsive purchase. They were in North Carolina on vacation and bought a plot of land. They plan to build a house on it over the next couple of years and by the time they retire it will be ready for them to move in. Being a gerontology student and always thinking about long-term care needs, I babbled on for a few minutes about universal design. If they intend to build this home and stay in it for as long as possible, I told my friend, then they should consider their future needs.
Recent statistics show that about 80% of baby boomers want to remain in their homes for as long as possible (and Obama’s new Affordable Care Act may help them do just that with the Community Living Assistance Services and Supports (CLASS) program and the expansion of Home and Community-Based Services. A story for another time). If you start planning for it now, you don’t have to have oodles of money to build a house from scratch like my friend’s parents. Let me share with you what I feel are the key components of universal design and home modifications:
- Think About Daily Activities – when modifying your home to support you in old age focus on making it easy to perform basic activities like bathing, cooking, or getting into and out of your home. Examples:
- Install grab bars in the bathroom
- Replace doorknobs or faucet handles with lever handles
- Install handrails on both sides of any staircases inside or outside your home (or consider ramps)
- Create some easy access storage in the kitchen such as a pull-out pantry or adjustable shelves
- Consider the Age of Your Home – Most older adults live in homes that are over 20 years old and these can have some issues as you age. Some updates to your home can help you age in place. Examples:
- Install proper insulation, storm windows, and air conditioning so you have good heating and ventilation
- Create 36-inch wide doorways throughout the house for easy access with a wheelchair or walker
- Move outlets 18-inches off the floor so you’ll be able to reach them without much bending
- Put your laundry on the main floor (definitely get it out of the basement!)
- Make Safety a Priority – Think about your aging parents. What parts of their home make you nervous? The clutter, the dim lighting, the slippery bathroom? These may also become a safety concern for you one day. Examples:
- Get rid of throw rugs (they are very hazardous!)
- Place non-slip strips in the bath tub, the kitchen and on any outdoor or indoor stairways
- Install bright lighting inside and outside the home, and make sure switches are easy to use and access
- Rearrange your furniture so there is plenty of space to move around a room
There are many companies out there that will sell you some pretty sleek looking products. You definitely do not need to spend that kind of money, but I think some people fear their home will look like a hospital if they integrate basic universal design. Just remember this is entirely up to you, your tastes and your budget. If you start planning for it now and modify your home over time the benefits could greatly outweigh the costs. Below are some resources if you are interested in learning more:
National Resource Center on Supportive Housing and Home Modification
US Department of Health and Human Services