Long-Term Care Issues In The US

What is the 'Sandwich Generation' in regard to long-term care?

The term the Sandwich Generation refers to people who are in that age group where they probably still have some kids at home that they are providing for, or the kinds are independent of them and they are also caring for their elderly parents. So it's sort of the double whammy.

Who can help me make decisions about long-term care?

As far as making decisions for long-term care, whether it be for you or for your family, the more people you can talk to the better, particularly people who work in the industry and people in your community or your loved ones who have experience with it. There is just no substitute for actual experience and going out and actually seeing places, and talking to people who live in these places. I would also encourage you to consider talking to geriatric care managers of various types. There are a variety of social service agencies, area agencies on aging and other sorts of senior care resources in every community. The more people you can talk to, the more informed decision you will be able to ultimately make.

Why is long-term care such a hot issue right now?

Long-term care is a very hot issue these days because we baby boomers are hitting the golden age. I think that just in the last year or two the first of us hit sixty-five and so there is going to be an explosion of care needs, long-term care needs for this generation. It is going to be a huge financial burden, and who knows where that money is going to come from. Also, I think people are wanting more individualized care, more sort of person centred care, which is a term we are hearing more and more lately, which is a good thing. So it is a very hot topic and hopefully with this culture change the notion of long term care will be less of a picture of just a bunch of old people tied down to their beds waiting to die in A nursing home, and more of a vibrant culture that respects people and sees them as individuals, and is just a place where they go live out their years, but with respect and comfort.

What is the biggest problem with the long-term health care system in the US?

The biggest problem with the long-term care system in the United States right now, I guess it just depends on who you ask. I think one thing that I find troubling is that with Medicaid they will pay for someone to be in a nursing home, but someone with the exact same medical needs, Medicaid will not pay for them to be in a lower level of care. So we see people in nursing homes that really could be at a lower level of care. I believe their quality of life would probably be a lot better at a lower level of care. And, it would cost us taxpayers a lot less dollars. You know you're talking maybe $4,500 in a nursing home and that could be $2,000. That's a lot of money. If you look at the numbers of people who are receiving custodial care. So, I guess, at least from a general public health and public finance standpoint, I'd say that's one of the biggest issues or problems.

How many Americans can't afford long-term health care?

As far as how many Americans can't afford long-term health care, that's a difficult question because if they're destitute enough, if you have less than $3000 dollars in the bank and very little in the way of tangible assets, then you can get Medicaid, so you don't really have to worry as long as you have a certain level of care needs with your activities and daily living. As far as the number of Americans who can't afford long-term care, I don't have a good estimate of the number, but it's a very large number. It can be a devastating prospect when you wind up needing long-term care and you have some money saved, and maybe you wanted to give it to your kids. Or, your life savings essentially can get burned up in a matter of a year or two if you require long-term care at a fairly high level.

What happens if I can't afford long-term care?

If you or I or anyone is unable to pay for long-term healthcare or long-term care in any kind of a setting, it's a difficult situation. Usually, what ends up happening is you go through whatever assets you do have, you spend down essentially and then you can qualify for Medicaid, and that's assuming that you have enough care needs to qualify. Otherwise, some people end up homeless, some people end up living in shelters, and things of that nature, and there are elderly people who end up in exactly those situations. They're just a little too healthy to qualify for a nursing home, but a little too sick or a little too poor to be able to live in the community. Those are difficult issues and situations.

What reforms could change the long-term health care system?

As far as reforms that could change the long-term care system, I believe that probably one of the first and best things to do would be to try to shift people to lower levels of care and. There's just no reason for somebody who has trouble walking, bathing and dressing themselves to be in a nursing home. That person could easily be in assisted living or in a community setting with some either part time or full time assistance, and certainly the assisted living would be far less expensive. So I think finding a way to lower the level of care for people who don't need a level of care such as that given in a skilled nursing facility, would be a good first step.

What is the single biggest misconception about long-term care?

The single biggest misconception about long-term care is that nursing homes are just stinky, horrible old places. Back in the 1980's, there was legislation, the OBRA legislation, that created sweeping changes in the way nursing homes are run. On the one hand, it made them far more regulated. Next to the nuclear industry, it is the most regulated industry in the United States. Nursing homes have become a lot nicer. They've also become almost like the hospitals of fifteen years ago, so nursing homes can take care of sick people. We put people on IV antibiotics, we do complex wound care, and so you have to get even sicker now to be in the hospital, and you can be mighty sick and still be in a nursing facility. The Assisted Livings of today are like nursing homes were fifteen or twenty years ago, so there has been a shift of people to basically lower the levels of care.