This week’s section of HR 676 (Improved and Expanded Medicare for All) is Section 203—Payment for Long Term Care.
For long-term care, which includes in-home, nursing home and community based care, each region will get a lump sum amount to cover everything—regions will distribute the money to care providers. Instead of paying for each service provided, the nursing homes and other care providers will get a global budget based on their past expenditures, performance, utilization and expected changes in service. There will be an effort to favor care in the home or community instead of in institutions.
How many of you are struggling to take care of aging or disabled family members right now, with or without long-term care insurance? I’d love to hear some stories. How many of you have long-term care insurance for yourselves? Many of us try not to think about it—we don’t want to be a burden on our children one day, but the cost of insurance can be fairly high.
I have an adult disabled family member. Between Medicaid and my work insurance, most regular medical care is covered. Because my family member had no long-term care insurance before becoming ill as a minor, the many non-medical expenses aren’t covered at all. I’m talking about things like assistants to help get to doctor appointments, buy groceries/help plan one or two meals a day, help remember basic maintenance tasks like laundry and cleaning, help plan/ accomplish goals and provide some of the critical human companionship we all need to stay healthy. Of course, when we are not at work, we also pitch in as a family and enjoy spending time with each other.
Because it would be hard for one person to manage (and because we wanted some backup in case one person needed time off), we cobbled together a plan of care with several part-time helpers who do a wonderful job.
We are fortunate that we can afford it—we wish we could afford even more help. Many families can’t even come close. We worry about what will happen when we are gone, and we just signed a Special Needs Trust today—kind of eerie to realize we are worth more dead than alive. Even with life insurance money, there is a limit to how many years of care we can cover. We’re both hoping to live a long time and never retire! No bungee jumping for us. Without us, and without long-term care insurance, the little bit of disability money that barely covers rent will not be enough.
I think it is absolutely amazing to have this long-term care be part of the plan. It literally makes me tear up to imagine. Muscles relax that I didn’t even know were tense. And I wonder if it will wind up saving money in other ways. How many people, with proper care, could overcome disabilities and return to the community to work? How many would be less afraid to work intermittently—afraid of losing Medicaid or Medicare attached to their disability, because the loss of coverage would most likely doom them to the return of illness?
The only part of this section I wonder about is that all long-term care has to be done by agencies because of the global budget. There would not be a way for families to individually pay for assistance, the way we do now, so we would lose some personal control. It may be that this is the only way to set up long-term care in a cost-effective manner. If so, I’m not complaining. What do you think?
I have not done research into how other countries, such as Canada, accomplish the long-term care aspect of cradle to grave health care. However, I will never forget a Canadian’s reply to my wife and me about long-term care. After living in Canada for 4.5 years and having many of my Canadian co-workers now living and working in my city in Michigan, my wife and I happened to speak with a Canadian a few years ago here in Michigan. Joan, the Canadian, happened to mention that she and her husband are definitely returning to Canada. She also mentioned that her father is getting fine long-term care in Canada. Yes, it’s input from just one person in one family. but my guess is that it can be confirmed that long-term care is generally fine in Canada, especially considering the horrific experiences that some families have experienced in the States.
About your question “what do you think” about how we’ll do it. I could care less about losing some personal control. I one to be part of a one-tier system, not 1st class and 2nd class. Those with money who want to get superior care in a semi-luxurious or “better” setting will always have that option. I am guessing that some people will go around the system for long-term care. I just want to be part of the “masses” who will show their card and get care, like that Joan’s father, above, who is doing just fine in his nursing home.
As I wrote the first part, above, I was reminded of the following:
—- Canadians love their health care, as indicated by the data …
http://mforall.org/p/944
—- Canadians love their health care, as indicated by the video (and the transcript excerpts)… of 11 Canadians ages 40 to 90
http://mforall.org/p/995
—- Canadian-Americans who love their Canadian health care, as indicate by their experiences, including the two families who describe themselves an exiles from the United States
http://mforall.org/p/742#cantcomehome
- Bob the Health and Health Care Advocate.
I agree– as far as choices go, I wasn’t talking about luxury. I just meant that sometimes, especially in cases of mental illness disability, it takes time to find the right caregivers. You don’t necessarily want a “sitter” so much as someone who will treat your loved one like a human being. We have had some unfortunate experiences. Some people who go into that field are competent but not caring or respectful. Others are downright dangerous. One attendant left our family member in a van full of other disabled people with the engine/ AC off and the windows closed in the middle of the hot summer while he waited in line at the bank for half an hour. But I imagine that if agencies were getting fairly paid for their services, families would be able to insist on access to compassionate caregivers.
Good follow-up, especially about people getting fairly paid, which is often lacking in the United States, as I have observed and read. To the extent that anyone knows about the subject in other countries I look forward to reading here any further hints and / or facts about long-term care in other free-market countries.