The future of long term home care for the baby boomer generation

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The future of long term home care for the baby boomer generation

 

Paying for Long Term Home Care

 

Most people in the United States probably believe that when they get older and need care, the government will provide it for them. This seems perfectly logical since we are all paying into social security and other assorted taxes. The realty is quite different and will not likely to change either. What is the future of long term care for the elderly?

For the poor and the rich, Long Term Care is not as much of an issue. Medicaid will cover some or most of the cost of long term care for the poor.  Medicaid is funded by a partnership between the federal and state governments. Those with almost no assets qualify for Medicaid.  The rich also don’t have an issue since they will have choices which won’t depend on finances.

Most of us in the middle likely assume that Medicare will pay for the support that is needed as we age and need help.  The truth is that Medicare does not pay for the support care that we likely will need.

Medicare will pay for e.g. hospital stays, hospice care and certain Nursing Home stays.  Medicare does pay for Home Health Care. Unfortunately Home Health Care is not what we imagine it to be.  Home Health Care refers to certain skilled needs that a patient might have e.g. Physical therapy or Occupational Therapy or Wound care etc.  Medicare provides limited coverage for a short period of time. The bottom line is that Medicare does not pay for ones long term care needs.

When one thinks of elderly family members long term care, they might think that means Medicare funded long term stay in a nursing home. This is also not the case. Medicare does not pay for long term stays in a Nursing Home. Usually a person is eligible for 21 days.  Most people in Nursing Homes that are covered by Medicare are in for a short time only.

One can live in a Nursing Home but has to be paid for out of pocket i.e. out of their or their family’s pocket.  Nursing Home care is very expensive.  Depending on the location and other factors, Nursing Home Care costs at least $6000/month.

The great majority of the elderly live either at home or in some kind of aging care community.  Both options are paid for out of pocket.

Move out or remain at home

The great majority of people would prefer to remain in their own homes and most do so.  When they need help either the spouse or other family members will provide the assistance.  With the advent of the Coronavirus, this option has become even more urgent. Home Care is the safest option with Nursing Homes being the most dangerous.  Even though living at home is the preferred choice sometimes it’s just not possible.  Home Care requires a lot of organization and coordination. If there is a spouse or nearby children or relatives that are willing and able to shoulder some of the burden then that can make things doable.

For most people, this becomes after the person has a fall. A typical scenario is one in which the elderly person has a fall, likely in the bathroom and breaks a hip. There is a short hospital stay and then 21 days in a rehab facility.  It is at this point that the family gets into crisis mode and tried to figure out the minefield that is our healthcare system. They quickly have to decide what is needed and where the help will come from.

After the Medicare funded hospital and/or rehab stay, the client will return home.  Modifications can be made to the house in order to make it safer and prevent future falls and injury. Decluttering, installing hand rails. Eliminating rugs that could cause someone to fall.  Improved lighting.  Some of the safety equipment will be provided by Medicare. They will also leave the hospital with a shopping bag full of medications that have to be managed.

As mentioned Medicare will provide for the skilled needs for a limited period at home. This needs to be coordinated. Add things like meals and doctors’ appointments that have to be arranged.  In most cases the spouse with hopefully a lot of input form the adult children will somehow manage to get this under control.  If it’s all managed well the patient can expect to live a happy and normal life for many years albeit under these changed circumstances.

What we absolutely must avoid is having the caring spouse crack under the strain. Even though the spouse will tell everyone that they are doing fine and managing the situation – they might not be. The elderly are most afraid of losing their independence.  They risk losing control of their lives if they can’t take care of themselves.

Home Care vs Senior Living Communities.

If it is all too much and the family cannot get the situation managed then either the client moves out of the house into a community or outside in-home care is brought in. In-Home care involves a caregiver visiting for a period of time either every days or every week for a few hours to take care of the client. Home Care is expensive but so it moving into a community.  There are advantages and disadvantages of both

Senior Living Communities

It is logical that people of a certain age would want to move into a retirement community. The facilities can be beautiful. There are typically activities and there is socialization. All these provide joy and peace for the elderly and their families.    Moving into a community is a huge step. Selling the house, downsizing, changing the neighborhood. All of these can be daunting but many people do it and it works well. Most people who have made the move believe that it was the best thing.  In many communities there are different levels of care available so as people age and need more care, they can move from their independent living into assisted living. This means that they can live out their lives in this community without having to move again.

 

Home Care

The client remains in their own home. A caregiver visits at their convenience and provides one on one care. They can go out to the doctors’ appointments, restaurants. There is a close bond that can form between the caregiver and clients especially if there is continuity of care whereby the same caregiver is the one that provides the care every visit. The caregiver can give the family better information about the clients’ state because they see them regularly.   Home Care is competitively priced in relation to moving into a retirement community

 

Future of Long Term Care

Since we know that the baby boomer bubble will be needing increasing amounts of care in the near future, what can or should the government do?  There is not enough government money to provide for the care that most people actually need. In-home care is the preferred solution for almost everyone. It is the least expensive since people continue to live in their own homes.  Unfortunately in the future, it will become increasingly unaffordable as both minimum wage and government regulations increase. This will lead to fewer people being able to afford in-home care.

Technological improvements will help improve elder care with people being able to live independently more safely in their homes.  Because humans aren’t machines and every ones’ situation is different, it is unlikely that technology will be able to solve much of this issue. Everyone has different needs, personalities, histories and requirements. Technology is mostly a one size fits all solution.

The government needs a private – public partnership that is courageous and imaginative and non-partisan. Any solution should be on a sliding scale whereby those with greater means get fewer benefits. Medicare will need to pick up more of the cost of home care since keeping people at home is always going to be cheaper for those who are reasonably independent and wish to remain that way.

The inefficiencies of distance and the benefits of cluster care.

If caregivers have all their patients in a small geographic area, they can visit many more people in a typical shift. Labor cost is what makes home care so expensive and travel time is a key factor. Most people living independently need only a few hours of services daily. A caregiver should be able to spend an hour with a client and walk next door to the next client rather than getting in the car and driving across town. If their clients are spread out they spend most of time traveling and not helping the clients. Community living is the most efficient way of making this happen. The government could incentivize this type a living arrangement through tax incentives etc.

There are many retirement communities all over the country however the home care that is available is very expensive. Medicare available for home care could be viable if cluster care was available hence having the government incentivize cluster living.

Most of us Americans will be reliant on the government helping fund some part of our long term care and it really doesn’t look like this be likely unless long term strategies are put in place.  Most Americans will be affected and likely believe that it is the responsibility of the state or federal government to ensure that we all have access to long term home care especially since the majority of us have been paying into the fund for our entire working lives.