On The Brink Of A Tragedy
The Sad State Of Long Term Care In The U.S.
A former guest of ours on The Art 2 Aging podcast, Gary Buzzard, writes a great newsletter over at Medium.com.
His focus is on aging and meditation. Gary is 79 and his mind is sharp.
Every week he writes something about being older and getting older. Sometimes he laments being 79 but most of the time his tone and words are positive and uplifting.
However, a recent missive of his takes a sad tone and it has to do with the state of long term care in the United States (this is important with the election coming next Tuesday).
Gary begins by pointing out that six to eight million Americans aged 65 and older live in poverty. That’s about 10 percent of all Americans, he claims.
Then he cites the Administration on Aging’s estimate that at least 70 percent of those who are 65 today will need some kind of long-term care. The older you are, the more likely you’ll need it.
Given the nature of most healthcare in the U.S., there is a price tag attached to getting older. While America’s Medicaid can provide some assistance, the waiting list, of course, is ridiculously long so the odds are that you’ll die before you get in.
Here’s a New York Times story that underscores the point. The story was written last year. In a couple of days, Americans vote for a new President. One candidate promises to provide help on this matter while the other, well, you know.
The alternative to endless wait lists is that you can always use up all your financial resources and go broke when you’re still alive.
Nice choice.
Gary goes on to illustrate how long term care works in Europe. He points to Germany as a shining beacon of long-term care assistance and I encourage you to read his piece on the matter.
Most European nations have figured out health care and while costs have been rising dramatically in Europe as they have been in North America, they have the right funding models in place and no one but no one goes bankrupt trying to live with some degree of dignity.
There does exist an insurance option for long term care. It is called, obviously, long term care insurance or LTC for short. The point of the coverage is to pay a sum of money each month to the insured individual so he or she can use the funds to purchase help.
To qualify, a person has to be unable to perform the majority of what are called the “activities of daily living” which amount to the following:
· You need assistance to toilet
· You need assistance to dress
· You need assistance to eat
· You need assistance to bathe
· You need assistance to walk
The monthly amounts you receive with LTC coverage are strictly driven by the size of the premium you pay each month (the premiums are suspended when coverage begins and remain suspended for the duration of the coverage need).
As you can imagine, LTC coverage is not cheap. You can’t get it if you’re over the age of 71 (usually) and like all forms of personal insurance coverage, you have to be healthy at the time you apply. Otherwise you’ll face what insurers refer to as a ‘rating’ which is insurance-speak for paying more each month.
Consequently, the best time to apply is likely in your 50s when you are healthy (here’s hoping). Your premiums will also be less than if you were 60 or older, healthy or not.
It’s easy to see the difficulties older people will run into with this form of insurance. In theory, it’s a great idea but in practice, people are frequently denied the coverage by an insurer for health reasons.
In fact, the aging population in general has forced insurers to rewrite their mortality tables as we live longer – but too often with consequences – and that has given them carte blanche to jack up the premiums. I mean, if they’re paying you $3000 a month and you might live another 15 years or more – and you’re one of millions of LTC beneficiaries who are living longer (with consequences) – it makes actuaries cringe and CFOs lose sleep.
So the simplest solution is “charge ‘em more!”
Gary points out in his story on Medium that long term care is not a right but a privilege in the U.S. Which is no different from the rest of the healthcare system. If you’ve got the dough, then you’re good to go.
What a shame.
As Jack Nicholson’s character in The Departed proclaims, “No tickee, no laundry.”
Let’s hope that, come Tuesday night, there’s a clear winner and that she actually does something about this situation.