Marilee Driscoll is a professional speaker and the leading objective authority on all the ways to plan for long-term care. She is the author of The Complete Idiot's Guide to Long-term Care Planning, and the founder of Long-Term Care Planning Month.  She has been quoted in hundreds of publications, including AARP magazine, USA Weekend, Kiplinger's Personal Finance and The Wall Street Journal, and has been interviewed on the CBS Early Show.

Marilee Driscoll--

What Does CHANGE Look Like Relative to Long-Term Care?

Long-term care has as much of a chance of getting the next administration’s attention as a snowball surviving an Illinois – or Arizona - summer. If you’re worried about the solvency of Social Security and Medicare as the baby boomers age, bringing an unparalleled burden to these systems, then you should REALLY be worried about Medicaid, the welfare program which funds most long-term nursing home care. Not to mention the fact that there is no government plan that baby boomers and their parents can consistently rely upon to pay for care at home or in more attractive settings than nursing homes. Or that far less than 10% of Americans age 65+ have private long-term care insurance to pay for their care.

The next 60 words, italics added, is what the Obama campaign site says about long-term care: Strengthen Long-Term Care Options : As President, Obama will work to give seniors choices about their care, consistent with their needs, and not biased towards institutional care. He will work to reform the financing of long-term care to protect seniors and families. He will work to improve the quality of elder care, including by training more nurses and health care workers.

What do I think? Well, what’s not to love? In terms of critique, where do I start? Obama’s statement acknowledges the fact that the current financing system (read Medicaid) is biased towards institutional care. We instinctively know that non-institutional, home-based long-term care is what people want for themselves and their loved ones. Back in the early 1980’s, Congressman Claude Pepper acknowledged the “woodwork effect.” In other words, if the government Medicaid program started paying for long-term care where individuals wanted it (NOT in a nursing home), applicants for this taxpayer-funded program would “come out of the woodwork.” So, we must still ask, if the government starts funding more home-based and non-nursing home care, will overall spending increase due to increased demand for these services. Few Americans have private long-term care insurance, and there is no payroll tax or other program that baby boomers are paying into now to prefund their care.

On to sentence two! What kind of financing reform will “protect seniors and families?” The Deficit Reduction Act of 2005 included Medicaid reforms that made it tougher for individuals to do last-minute Medicaid planning, and also, for the first time, included the primary residence in financial qualifications. Should a family be allowed to preserve an inheritance or a family home, while taxpayers pay for the long-term care provided to a family member? A tough question, but one that must be asked...and the answer legislated.

As for the last sentence, “working to improve the quality of elder care…training more nurses and health care workers.” Nothing there to argue with - however, the reality is that LTC workers are among the lowest-paid workers. They earn little more than fast-food wages for doing extremely stressful, often repugnant and sometimes dangerous work. Few people want these jobs, and, as long as the pay is so low, that will not change. Who will pay the higher wages and benefits needed to make these jobs attractive? Given that the LTC financing and delivery system is barely hanging on by its fingernails now, I can’t wrap my brain around a good solution that doesn’t involve a lot of pain.

OK. Next? How will John McCain deal with LTC? Here’s what I found at his web site (italics added).

John McCain Will Develop A Strategy For Meeting The Challenge Of A Population Needing Greater Long-Term Care. There have been a variety of state-based experiments such as Cash and Counseling or The Program of All-Inclusive Care for the Elderly (PACE) that are pioneering approaches for delivering care to people in a home setting. Seniors are given a monthly stipend which they can use to hire workers and purchase care-related services and goods. They can get help managing their care by designating representatives, such as relatives or friends, to help make decisions. It also offers counseling and bookkeeping services to assist consumers in handling their programmatic responsibilities.

Huh? Upon further reflection, the first sentence says it all. “John McCain Will Develop A Strategy…”  As in the future. Because the rest of the paragraph is a re-hash of a “variety of state-based experiments,” primarily PACE. And, like apple pie and babies, what’s not to love about PACE? How can you not like money given to seniors to pay for care in their own home (unless it’s your money)? Only 15 states have chosen to implement PACE programs, which is curious, since they have been available since the early 1980’s. PACE is funded by both Medicare and Medicaid, which means that recipients must be both financially and medically needy. PACE may be a viable option for the poor, but the big question is how to fund LTC for the middle-class and upper-middle class.

So, it seems that we’ll have to wait to find out exactly what, if any, long-term care reforms these candidates will champion. Health care reform (meaning getting more Americans under age 65 insured for health care), not long-term care reform, is again major theme in a presidential campaign. Meanwhile, consistent with prior campaigns and administrations, the Titanic of an unsustainable LTC funding system is progressing full-steam ahead into the iceberg of aging baby boomers’ unfunded long-term care needs. Will LTC funding reform ever be a priority, before baby boomers need LTC? Or will we wait until the ship goes down?

Read McCain on LTC                 Read Obama on LTC

Related--

Long Term Care Planning Tips

Should You Purchase Longevity Insurance?

Update on Sep 26, 2008 by At Basil & Spice

Wall Street Journal!    Reuters-Business!     Reuters!