Elder Care Must Be Given Priority

Published in The Journal News April 22, 2000

     The United States healthcare budget faces unprecedented pressure from several key demographic realities. People are living longer, which means that they receive Medicare, Medicaid and Social Security benefits for many years. Also, an increasing number of Americans will turn 65 each year, with a sharp upturn expected in 2011 as the first members of the baby-boom generation hit the 65-year mark. Thus, for the foreseeable future, the growing elder population will continue to challenge our ability to care for older patients.

     Already more than 12 million Americans, mostly elderly, report needing some type of long-term care. To add insult to injury, older Americans who develop chronic and debilitating illnesses receive no coverage from Medicare because they need only "custodial" care.

     If we are to provide appropriate care for the increasing number of older patients who are not capable of caring for themselves, it is of critical importance that health-care resources be used efficiently.

     Long-term care is not one, unified program, but many different support services aimed at helping people who have lost some capacity for self-care due to a chronic condition or illness. These patients require the help of others to perform what are referred to as "activities of daily living," including eating/feeding, bathing, dressing and moving from bed to chair. In theory, long-term care patients are personally responsible for paying the complete costs of their home-care, nursing home or assisted-living needs. Such care can easily cost $50,000 per year or more. For people who live in the New York metropolitan area, the average annual nursing home bill often exceeds $90,000.

     How are these services paid for? Medicare, the health insurer for older Americans, does not cover long-term custodial care, either in nursing homes or at home.

     Medicaid does cover such care, but only if a patient meets stringent eligibility requirements that include an income and assets "ceiling." Simply put, poverty is a prerequisite for participation in the Medicaid program. This forces many older patients and their families to pay privately for elder care, usually with great financial difficulty and stress. Most older Americans who need long-term care cannot qualify for Medicaid until they have exhausted their life savings. In nearly every state, a patient must have less than $2,000 (New York, $3,600) in countable assets before qualifying for Medicaid. Despite these restrictions, government programs pay for almost 70 percent of the long-term care needs of older patients.

     Fortunately, a majority of older Americans spend their later years in relatively good health, but still, not every older person can maintain independent and healthy living. Many fragile nursing home patients require the assistance of not one, but two trained aides just to transfer them from side to side at least once every 90 minutes. Elder care remains a people business; there are no computers or robots that can substitute for a compassionate caregiver.

     As we make the transition from a predominantly young to a predominantly old population – a trend we now term "the graying of America" – we must recognize that unless we treat elder care as a scarce resource, there will not be enough care-givers to meet the demands of growing numbers of older patients. Although the competition for the limited supply of available caregivers is fierce, the needs of the patients are inelastic in economic terms. A bedridden patient is not going to suddenly get up and walk just because there is a labor shortage. Already ombudsmen from 41 states report that nursing homes cannot recruit or retain the nurse’s aides they need. Just imagine what it will be like for baby-boomers 25 years from now, when the number of people 65 and older has risen 75 percent, while the number of workers has risen by only 15 percent.

     Today’s older patients could not have predicted the medical advances that have increased their life expectancies. Nonetheless, in order to avoid a crisis, in the very near future, the government must make structural changes that will provide for elder care needs without penalizing future generation.

The writer, Thomas Cassidy, is a senior fellow at the Institute for SocioEconomic Studies, in White Plains, NY