Today's seniors enjoy a life expectancy longer than
any generation in history. An American who turned 65 in 1998 could expect to
live nearly another 18 years beyond their 65th birthday. And while additional
years are generally considered an blessing, it is also true that the older one
grows, the more likely they will need health care services. Today's seniors,
who often consider themselves among the best informed, would do well to learn
about three crucial areas that pertain to their future health care needs: the
potential that they may need long term care, the cost of long term care and the
limited federal and state aid available.
According to a study by the Agency for Health Care
Policy and Research, some 42 percent of Americans who reach the age of 70 can
expect to utilize some type of long term care during the remainder of their
lives. And with the number of people over age 65 expected to grow to 20 percent
of the U.S. population by 2030, there is little doubt that demand for long term
care services is poised to increase dramatically.
Long term care services have evolved dramatically
over the past several years. Where the majority of long term care was once
provided only in skilled nursing homes, long term care services today are
provided in a wide range of settings, ranging from in-home care to
community-based facilities such as adult day care and assisted care facilities
to nursing homes. The cost of long term care can be significant, regardless of
the setting in which it is provided. The average cost of a nursing home is
approximately $60,000 a year, and home care costs can range from $50 to more
than $250 a day.
Medicare and Medicaid provide only limited help for
nursing home care. Medicare only pays for the first 20 days in a skilled
nursing facility - and only after a hospital stay of three days or more. The
patient or their family pays the first $99 per day from the 21st day through
the 100th day, after which Medicare pays nothing. Medicaid rules vary from
state to state, but as former U.S. Senator David Durenburger told the U.S.
Senate Special Committee on Aging, Medicaid "dictates that people must
effectively impoverish themselves in order to receive government
assistance." Medicaid is essentially medical aide for those who have
already spent down their assets.
Government won't help much with newer forms of long
term care services, either. Though 38 states pay for some assisted living, the
programs are miniscule, covering fewer than 100,000 poor people, so waiting
lists are long. Medicare covers home care, but just 100 visits in the weeks
following a hospital stay. So seniors increasingly are paying their long term
care bills out of their own pockets.
Medicaid does not pay for assisted living services
in most assisted living, typically they cover the costs of care in Nursing Homes for those
who have exhausted their assets. The White House recently authorized Medicare
coverage for the treatment of Alzheimer's disease. This means that Medicare
beneficiaries can now receive reimbursement for mental health services that
were formerly denied because the government rationalized that people with the
disease did not respond to mental and physical therapy, this has since been
proven incorrect, hence the reversal of their position. Medicare was never
intended to cover the costs associated with custodial care, which is room and
board, and activities of daily living, and these coverage changes still do not
reimburse for this, further Medicare requires a three-day prequalifying
hospital stay before they pay for care in a nursing home. Medicare covers
certain care procedures, and some limited rehabilitation therapies. The
physicians who visit assisted living are normally all Medicare certified providers, so the
cost of their visits is often covered by Medicare, subject to the co-payment.
