Navigating the Long Term Care
System in 2005
© 2005 Charlie Robinson
November 15, 2005
When a senior citizen
suffers from acute illness such as heart disease or cancer, the individual
and her family work through a variety of health care options. What is best
for the elder patient- surgery followed by chemotherapy or radiation, or is
the most effective treatment non-surgical?
Whatever the final course
of treatment may be in acute illness, there is one common comfort- the
necessary procedures for the chosen course of treatment will be mostly or
completely covered by Medicare and a relatively inexpensive supplement or by
a managed care plan leaving patient share of cost from hundreds to a few
thousand dollars.
A senior stricken by
chronic illness such as stroke, Alzheimer’s disease, Parkinson’s, ALS (Lou
Gehrig’s), MS, has a different scenario to deal with. Chronic illness is at
least as devastating to an individual and her family as acute. In
Alzheimer’s we watch a parent, sibling or friend lose the ability to take
care of personal needs and become a virtual stranger to the person we have
known and loved.
On top of the care needs,
the chronically ill must risk her hard-earned financial security as well as
her health. If long term care starts with a hospital stay of at least three
days followed by the need for skilled or rehabilitative care, the most
covered care possible for most folks will be an additional 100 days of
Medicare coverage. After the rehab is terminated the elder or her family
have three possible sources of payment;
- Private pay currently
ranging from $2,000 or higher in assisted living to nursing care at a
current rate of $5,000 or more per month, not including prescription
costs.
- Long term care
insurance. We have seen too many cases where long term care insurance,
which I recommend to clients in good health with the ability to pay the
premiums, is insufficient to keep pace with the rising private pay long
term care costs.
- Medicaid which has
become a tattered, changing safety net for the chronically ill.
Elder law attorneys have
spent the last 20 years or so helping families protect assets when an elder
is afflicted with chronic illness. Medicaid is the only program for the
chronically ill and also the only program that requires the ill person to
repay the government for care services. Medicare has no repayment
requirement. More seniors and their families should be asking why the
chronically ill must suffer from disease discrimination.
The elder law bar has
also spent the last twenty years advocating systemic change that will
eliminate the need to provide asset protection services by allowing
chronically ill persons, mostly seniors, to be cared for without significant
financial risk in the same manner as those with acute illness. So far, our
efforts aren’t working.
Instead of a system that
is more consumer-friendly, we are faced with a system more complex and
convoluted than ever.
Our political leaders
seem to have singled out Medicaid recipients as a target for budget reform
while spending in other areas runs rampant. It is important to our culture
and our society that we do not punish elders for contracting the wrong
disease. |
