The Real Long-Term Care System
I doubt that very many readers of this magazine would dispute that the bulk of “long-term care” in this country is provided by family members in the home setting. Assisted living is for people with specific ADL limitations who are privileged to have access to private funding from home sales, personal savings, or relatively well-heeled families. Nursing homes are for those needing intensive assistance with ADLs and/or financial help from Medicaid. Neither resident population comes close, in absolute numbers, to that being served by concerned relatives.

There are those who would argue that this is just as it should be. Family members should support each other. While individual circumstances differ considerably, that is also an argument for allowing as much flexibility as possible to work through a myriad of private arrangements-Meals on Wheels; visiting nurses; providers offering income-dependent, sliding-scale fees; and more. Long-term care is simply too personal, complicated, and expensive to expect any public program to meet most needs in relatively seamless fashion. This is especially true if people really mean it when they say they “want to stay home.”

There’s no question it’s expensive. A survey released recently by the Medicare Rights Center indicates that family caregivers provide about $196 billion in uncompensated care every year. It’s difficult to imagine any public program, especially in this tax-averse day and age, assuming even a respectable fraction of that responsibility. Even though family caregivers might be foregoing income, job advancement, and overall peace of mind to care for loved ones, these might well be things we just have to live with.

All of this presupposes, though, that resources and assistance will be available to families when they’re needed. What happens if caregivers “get lost in the system” or run out of resources? What if private-pay assisted living becomes generally unaffordable? What if nursing homes, already starved of government funding, end up closing their doors?

Considering the numbers involved-the Medicare Rights Center reports that 31% of adult Americans are providing uncompensated long-term care-this could set up an interesting little situation for Washington policymakers. Maybe that “wake-up call” we’ve all been waiting for will come a little sooner than we think. Will 2003 be the year? NH

To comment on the editorial, please send e-mail to peck0203@nursinghomesmagazine.com.

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