Health Care Reform Without Long-term Care Reform Is Ageism in Action

Long-term care is the ugly stepsister of health care reform

Here’s the truth. Health care in the last year of life is significantly more expensive than the cost of health care in preceding years. Almost 30% of Medicare spending is paid out for patients in the last year of their lives.

Strange but true, Medicare will pay for care for some health problems but not for others. For example, if you break your leg or have a heart attack, Medicare will cover the doctors, nurses, hospital, and short-term rehabilitation.

If you come down with Alzheimer’s disease, you’re on your own—except for an occasional doctor visit to refill a prescription. Need someone to help you bathe and dress and eat? You are on your own. Need someone to design a mental stimulation program to forestall decline? You are on your own. As the disease progresses, need someone to monitor your safety to make sure you don’t hurt yourself? Figure it out yourself because you will be on your own. Medicare will not spend one dime to help.

Here are startling statistics from the Alzheimer’s Association:

• As many as 5.3 million people in the United States are living with Alzheimer’s disease.
• Alzheimer’s disease and other dementias triple health care costs for Americans age 65 and older.
• Alzheimer’s disease is the seventh leading cause of death.

And yet, health care reform will not touch the cost, impact, and care for those living with Alzheimer’s. Why is this the case? Because most of the care is paid for by Medicaid.
 
Medicaid is our nation's largest health insurer, covering one in six Americans. It covers two-thirds of nursing home residents and one in five persons under age 65 with chronic disabilities. According to Dennis Smith, a senior research fellow in health care reform at the Heritage Foundation, about a third of 2007 Medicaid spending, or about $100 billion (that’s with a b for billion), went to long-term care. According to Smith, over the next 10 years, Medicaid long-term care spending is projected to grow at an average rate of 8.6% per year (80.6% over 10 years).

A host of regulatory changes should be made not only to reduce the cost of long-term care but also to move money now spent on nursing homes into the kinds of services that people actually want—services that allow people to remain at home. No one wants to die in a nursing home, but alternatives are limited in most states.

Long-term care is the ugly stepsister of health care reform. Sure, health care costs resulting from inefficient long-term care are skyrocketing, but unless medical providers can make a buck from providing health care services to old people, they are not interested in getting involved with the politics of long-term care. This is just another example of the invisibility that frail old people endure on a day-to-day basis.

By Sara Myers
A Good Enough Daughter Blog