The “sandwich generation” is confronted today with the dilemma that millions of other Americans already face: how to take care of loved ones who cannot do so for themselves.
The options on how to provide long-term care come as a shock to most people who find themselves in this situation. Medicare pays only for temporary nursing home stays, and regular health insurance policies don’t cover long-term care. Medicaid does, but only if a person spends down hard-earned assets to be poor enough to qualify. Oh, and when Medicaid does kick in, it tends to be skewed toward putting someone in costly nursing homes, rather than finding ways to help people stay in their own homes and communities as long as possible.
The millions of Americans who take on the caregiver burden themselves do it as a labor of love and find it utterly exhausting. Yet for all the pervasiveness of long-term care problems, possible solutions haven’t had a prominent place in this year’s health care debate. This just doesn’t seem to be the top priority on many lists.
One promising idea that deserves more attention than it has been getting is the Community Living Assistance Services and Supports (CLASS) Act. Championed by the late Sen. Edward Kennedy, it is included in some, but not all, of the reform measures being considered in Congress.
This plan would establish government-run, long-term insurance through payroll deductions. It would not be subsidized by employers, and people could opt out. After paying in for five years — with premiums of about $120 a month — people who became unable to take care of themselves would qualify for modest stipends of perhaps $50 to $75 a day.
That’s far below the $190-a-day average nursing home cost, but one potential benefit is that CLASS could focus Americans’ attention on long-term care issues. It might even kick-start interest in the fledgling private long-term care insurance market that provides more complete “wraparound” benefits.
The Congressional Budget Office and other analysts say the plan would take in $73 billion more than it pays out in the first 10 years. It would also likely reduce Medicaid costs, the single biggest budget item for most states. Private insurers warn, however, that the plan would give people a false sense of security and ultimately require big federal subsidies.
Given the history of government-run insurance programs and budgetary sleights of hand, sound long-term financing is a valid concern. CLASS might or might not be the best approach; other proposals would tweak Medicaid to help people stay at home longer, though they don’t address the need to be poor enough to qualify.
Whatever the approach, there can be little dispute that long-term care deserves as much attention as the “public option” or other flashpoints. More than 10 million people now need long-term care. That number is expected to soar as the Baby Boom generation ages and lifespan increase. The government should reward consumers who purchase long-term care insurance with substantial tax credits. By encouraging individuals to plan for their own care would take a big load off the state’s Medicaid program.