Caring for Caregivers: Dealing with Medicare's Long-Term Coverage

In my last post I explored the potential impact of the federal government's recent resolution to hold Medicare Part B premiums stable for 2009. While the decision will be beneficial to many Medicare recipients requiring doctor visits and other outpatient services, most of the patients and their families dealing with the costs of long-term care will see no such respite. Long-term care has for a while been the "Achilles heel" of health care reform advocates, as it is often overlooked in favor of the far more prominent aspects of health care such as prescription drug costs and doctors' fees. Many credit this to the prevalent assumption among middle-class Americans that Medicare (and more specifically Medicaid, which oversees most of the long-term care coverage that is funded by the government) will provide for them in their later years, and therefore fail to seek out other options that might save them money in the long haul, such as long-term care insurance. This plea for greater consumer awareness is heard from across the political spectrum. In a blog post titled "USA: Long-term care often left out of talks on health care reform," Emily P. Walker quotes senior fellows at both libertarian and conservative think tanks acknowledging the increased responsibility Americans must assume over their long-term care needs.

This week I surveyed the blogosphere to get a feel for how others viewed the public's perception of long-term health care, and the amount of reliance placed on a government program that explicitly lacks the provisions of adequate coverage for all but the poorest Americans. The first blog post I looked at was on AgingCare.com, a popular and informative resource aimed at caregivers. A survey of caregivers they had conducted reveals an overwhelming lack of predictability and planning concerning how caregivers were going to pay for their parents' care needs in the years ahead, as well as statistics regarding the current impact of care financing in the day-to-day lives of caregivers. The second blog post I looked at was part of "The New Old Age" blog hosted by the New York Times. Author Jane Gross explores a new government-sponsored website offered through Medicare aimed at caregivers, specifically with the intention of directing those who do not qualify for aid to other resources that might help to fill in the gaps. In addition to posting my comments directly in these blogs, I have excerpted them below:

"Cost of Caring for Aging Parents Could be Next Financial Crisis"
Comment:

As someone who is very curious to see just how we as a country are going to deal with the increasing number of elderly Americans who need long-term care in the coming years, I would like to thank you for highlighting such an important issue that is so often overlooked by policy-makers and the public. Your survey emphasizes the vast numbers of caregivers in this country who are struggling to finance the costs of caring for their parents while maintaining happy and healthy families of their own. I was especially shocked to read the overwhelming percentage of caregivers who had to make substantial sacrifices in their own careers as a result of caregiving responsibilities. This phenomenon, combined with the increasing costs of personal caregiving and the lack of government support leaves little wonder as to why so many have minimal foresight into maintaining that care in the future. The emotional toll this compilation of stresses takes on caregivers is ominous for the mental and physical health of our country, perhaps soon leading to a health crisis of its own, in addition to that already faced by the millions of aging individuals who require such devoted care. As articles such as this one circulate beyond the all-too-aware caregivers who are personally familiar with such grim statistics, we can be hopeful that the government and health care reform advocates who work to improve its programs recognize the need for long-term care improvement within the framework of a larger health care overhaul. Until then, increased awareness from the American public regarding the burdens they too may one day face can only be a positive thing.

"Medicare Reaches Out to Caregivers"

Comment:

While it would be nice if the American public needed to look no further than Medicare/Medicaid to receive the assistance it requires when paying for the long-term care costs incurred by so many aging individuals and their families, the new website directing inquiring consumers to other resources should hopefully be a useful compromise while we wait for an extensive overhaul of the health care system. Caregivers and their advocates have long been familiar with the gaping holes left by the long-term health care coverage provided by the federal government, but have often remained uncertain of where exactly to turn for help. This website is a positive force, both for those who currently struggle to obtain the care information they need, as well as a possible signal of recognition of the burdens long-term care stands to place on the average American from Medicare officials. Perhaps in the near future administrators who are aware of the overwhelming financial strains incurred by long-term care--such as Kerry Weems--will be given the necessary platform to initiate legislative reform. Until then, the website will have to suffice. As for the specific content of the new website, I appreciate the inclusion of non-government sources such as AARP and the Alzheimer's Association, which have long been vital mainstays of support to caregivers. Until Medicare evolves to include a larger portion of American taxpayers, it is crucial that these embattled individuals receive all the assistance they can get, and a centralized hub of resources available will certainly help to do so.

The Axis of Alzheimer's: Global prevalence is on the rise, while domestic Medicare policy changes fail to ease the financial burden of long-term care

This past Thursday, the world's oldest man celebrated his 113th birthday. It is fitting that Tomoji Tanabe, who wants to live "another five years or so," lives in the world's oldest country, Japan. Over a quarter of Japan's 127 million plus population is over the age of 60, and that number is expected to grow to 44% by the year 2050. Although Tanabe has been fortunate enough to enjoy relative good health in his late years, millions of others have not been so lucky.

Today, September 21, is World Alzheimer's Day. While enormous strides have been made in the understanding and treating of this harrowing disease, doctors, patients, and caregivers the world over champion for greater awareness and action. They continue to stress the need for increased research and care funding, as the United States and other countries struggle to assist those afflicted, a demographic bound only to increase as the world's population of elderly individuals grows. As the world observes this day of awareness, a reflection on a recent change to Medicare and the diminishing role of health care in the upcoming election indicates a need for increased focus on the financial aspect of long-term care for those suffering from Alzheimer's here in the U.S.

The most common form of dementia, Alzheimer's currently affects some five million Americans, and 26 million people worldwide. With the cause uncertain and no known cure (at best, current treatments have proven only to slow the loss of function associated with the disease), Alzheimer's is the sixth leading cause of death in the U.S. Alzheimer's is a degenerative disease of the brain, resulting in the loss of memory and cognition, and ultimately, the loss of bodily functions. Although the prognosis and duration can differ from person to person, Alzheimer's ultimately leads to death.

Despite the fact that Alzheimer's is commonly known as a disease of old age, a mounting number of cases are being diagnosed in patients in their 30s and 40s. That, combined with the growing proportion of Americans living longer makes for an estimate of 16 million that will be afflicted with the disease by the year 2050.

The crisis of how to handle elderly health care is an international one. As Japan struggles to finance health care insurance for their large population of senior citizens, France, Britain, and Germany are experiencing similar demographic shifts skewed toward the older populations that will mirror Japan's in the years to come. The charts on the right depict Japan's population based on age and sex. The one on the far right, projecting Japan's population in 2050, is in the shape of an inverted pyramid, demonstrative of a nation facing an increasing proportion of the elderly relative to younger and middle-aged adults. Here in the U.S., the state of Florida already has an elderly population proportional to Japan's, with Colorado expected to follow in 2020. As expected, greater numbers of aged individuals translate to greater numbers of Alzheimer's patients. Asia hosts half of the world's Alzheimer's cases with 12.6 million suffering from the disease, a number projected to jump to 62.8 million in 2050. Even developing countries, where prevalence rates of Alzheimer's were once incidental due to low life expectancies, are faced with how to deal with the epidemic as newfound prosperity increases longevity.

On Friday, the federal government stated that, for the first time since 2000 and only the sixth time in the history of Medicare, outpatient premiums will not increase in 2009. The premiums staying constant at $96.40 fall under Medicare Part B, which covers doctors' visits and other outpatient services. Although many Medicare recipients may see this as a positive step toward easing the cost of health care on the individual, it is doubtful this plan will assist those suffering from and caring for patients of Alzheimer's. Out-of-pocket nursing home care deductibles, an expense more commonly associated with caring for patients with Alzheimer's, will rise $44 to $1068 in 2009. Additionally, as it stands now, Medicare covers only skilled nursing facility or home health care deemed medically necessary, denying coverage for most long-term care. The pie chart on the left represents the national health expenditures for 2006. Most long-term care needs (those most commonly associated with Alzheimer's and other chronic illnesses) fall under the categories of home health care (3%) and nursing health care (6%). An offshoot of Medicare, Medicaid currently provides long-term coverage for low-income individuals and families, a program currently under reform with hopes of increasing choice in care options available to patients and families, improving the quality of long-term care offered, and reducing costs and supporting government tax law changes to provide for the private funding for long-term care needs.

For the millions afflicted with Alzheimer's here in the U.S., and the millions more in charge of their care, something in the way our government provides health care has to change. As the presidential election approaches amid crises in the stock market and mortgage industry (both of which make affordable health care that much more important as food and gas prices rise, often disproportionately affecting the elderly), health care reform advocates struggle to remain at the forefront of issues. While long-term care, particularly related to caring for those with Alzheimer's, isn't specifically the focus of the health-care debate, increased attention and insistent action from the American people can only stand to benefit the progress being made fighting the disease and caring for those who suffer from it here in the United States.