November 16, 2005
Wednesday

WASHINGTON - Although long-term care has come to be seen as a back-burner issue for much of Washington, a new survey finds Americans surprisingly concerned about how the country pays for custodial care of the elderly and disabled.

The poll shows that 7 in 10 baby boomers and senior citizens think the federal government should do more to help people meet the cost of long-term care, but most also agree that government and individuals should share responsibility for the cost.

The poll of 804 people ages 40 and older, done for the National Academy of Social Insurance, was released Monday along with a report by a panel of experts from the academy on potential reforms to the way the United States pays for long-term care.

"We really didn't expect that this many people would be familiar enough with problems with long-term care to make it a priority for them, but the awareness that this is a serious policy problem that requires change was quite high," said Judith Feder, co-chair of the committee and head of the Public Policy Institute at Georgetown University.

Even though the middle-aged and older are concerned about long-term-care policy, only 37 percent said they had a plan to pay for it.

"One reason for the low level of planning is that just 35 percent feel it is very likely that they or their spouse will ever need such care," said Gary Ferguson, senior vice president of the polling firm American Viewpoint, which did the survey along with Peter Hart Research Associates.

And, in fact, noted Sheila Burke, the panel's other co-chair and deputy secretary of the Smithsonian Institution, "the need for long-term care is not a certainty - 30 percent of people 65 and older will not need such care before they die."

Accordingly, the prospect of needing long-term care should be viewed as a risk and not a certainty, the committee said in its report, and thus be handled through insurance like other unpredictable and potentially financially catastrophic events.

Reflecting the ideological spectrum of the dozen experts on the committee - Feder was a health-care adviser in the Clinton administration, Burke was a top health-care aide to then-Senate Republican leader Robert Dole of Kansas - the experts didn't endorse any particular solution, but did outline two possible models.

One would have the government establish a basic long-term-care benefit for everyone, and encourage wealthier people to supplement the coverage with private insurance, while offering extra help to low-income seniors and disabled people.

The other idea is to set a new national floor for income and asset protection that would replace the current patchwork of Medicaid coverage for long-term care that varies from state to state.

Medicaid programs pay for about 47 percent of long-term-care expenses now, but benefits are available only after people "spend down" assets to poverty levels, and then may only cover certain types of care, such as nursing homes and home health visits. And both the states and the federal government have been moving toward imposing more restrictions or shedding responsibility for the services.

Medicare pays only for short-term nursing-home and rehab care, and private insurance only covers about 10 percent of long-term care. Additionally, only 6 million to 7 million people have any private coverage at all.

"Private coverage has improved somewhat in the past decade or so," Burke said. But she noted that benefits are often not generous enough, while annual premiums are running close to an average $3,000, well out of reach for all but about 10 percent to 20 percent of seniors.

Feder said the committee recognizes that with the federal government strapped for cash, a new health initiative may be a hard sell. However, "we need to make clear that the public really wants and needs the government to have a core role in taking care of these needs."

On the Net:

www.nasi.org

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