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Rethinking long-term care

By Jennie L. Phipps ·
Thursday, September 26, 2013
Posted: 6 pm ET

Retirement planning ought to include how we're going to pay for long-term care, but often people living in retirement avoid thinking about the issue until it's too late to find a good solution.

Thursday morning, Altarum Institute gathered a group of top health policy experts to consider ways to provide services and financing to people who need long-term care. They considered the reality that most people rely on friends and family. Only the desperate turn to public programs such as Medicaid and those offered by the U.S. Department of Veterans Affairs and some states. Even so, the costs -- both public and private -- are high and are likely to get higher as boomers age.

One of the panel members, Shannon Brownlee, senior vice president of the Lown Institute, whose mission is to limit medical care to treatments that are really necessary, talked about her own 84-year-old mother's experience of falling and breaking her pelvis. Brownlee's mother didn't need to be hospitalized, but she required lengthy bed rest. Because of Medicare rules that tie recuperative care to hospital stays, her mother didn't qualify for Medicare payments for much-needed temporary nursing help.

Brownlee and her brothers' solution was to fly their mother, first class, from Hawaii to California where they could care for her themselves. "People in my mother's situation whose family has less money and fewer resources than we have fall into a crevasse of suffering," Brownlee said.

Finding affordable solutions

The goal of the conference was to find answers to these kinds of dilemmas. Many solutions were put forward, but the bottom line was outlined by Joseph Antos, a policy expert from the American Enterprise Institute. He said this country isn't ready -- and may never be ready -- to expand Medicare to include payments for long-term care. And most people won't buy private long-term care insurance because it costs too much and they don't believe they will need it. Combining long-term care with a guaranteed life annuity gets around some of the problem, but even that's like "putting lipstick on a pig," Antos said.

"Private insurance has failed," agreed John Rother, president and CEO of the National Coalition On Health Care.

He argued that long-term care shouldn't be viewed as a health problem. "It's a disability issue and should be treated as one," he said.

He offered a couple of approaches that he said would involve redeploying tax money that is currently spent on less-effective solutions.

  • Liberalize Social Security Disability Insurance to include payments to people who are too young or who don't get enough Social Security retirement benefits to pay for their care. "People who are limited in their ability to function need cash. If we give it to them, they will find solutions that are much less expensive than we are paying for now," Rother told the audience.
  • Provide better coordination of care. "In New York City, our research says that on average, people older than 65 see 16 different care providers a year. If we can cut down on the overlap, we'll free up money to spend on other things," he said.
  • Find ways to prevent the onset of the most debilitating diseases affecting people older than 65 -- dementia, incontinence and broken hips. "We should aggressively support a research agenda that is targeted at preventing these problems," Rother said.

The best thing about this conference was that it identified solutions to providing long-term care that don't cost more money than we have to spend. To me, these ideas sounded like an enormous and refreshing step in the right direction.

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1 Comment
September 27, 2013 at 6:13 pm

Why no mention of Medicare paying for in-home supportive services? That would help tremendously, seems to me. They did but cut back? I'm not clear on that.