Pandemic Revealed and Magnified Problems with Long-Term Health Care

The COVID-19 virus crisis revealed the problem of long-term health care for the first time for many people in the United States and, in fact, worldwide. Too many people tended to ignore the consequences of aging and declining health until a crisis happened in their family. The pandemic exposed the problem and shined a light that aging is a significant family and financial situation and a health and well-being issue.

People generally knew that older people and those with disabilities received long-term care services either at home or in a facility. But many people were not aware of how many people needed help with daily living activities or supervision due to dementia. 

The public, in general, seemed to be also unaware of the quality of this care, the burdens informal family caregivers faced, and the costs of professional care providers and facilities. 

Many Still Unaware of Lack of Health Insurance Coverage for Long-Term Care

Even now, some people are unaware that health insurance, including Medicare and supplements, paid little to nothing for long-term health care services. 

Medicaid will indeed pay for long-term health care services, but only if the care recipient has little or no income and assets. The quality of that care has been questionable as the government reimbursements are fairly low. Most Medicaid long-term care services are provided in Medicaid nursing homes - the last place most people would prefer to receive care. 

There has been some expansion in some states to expand Medicaid long-term care service to offer community care, yet it remains primarily family care.

Caregivers Face Challenges

The COVID-19 virus crisis continues to impact older people and those with comorbid health problems especially hard. But the crisis, which was played out on TV, radio, and social media, exposed how hard being a caregiver can be. 

Being a caregiver in a long-term care facility or in someone's home has always been - a continues to be - a demanding job. When you add COVID-19 and other infectious diseases to the mix, the job also becomes dangerous. 

"We saw high death rates among our caregivers, but also lots of burnout, lots of attrition from the workforce," said David Grabowski, a professor of health care policy at Harvard Medical School where he studies long-term care and post-acute care for older adults.

In a roundtable sponsored by the American Medical Association, Grabowski said that long-term health care has always been desired to be provided in the community.

"When our family members or ourselves need to enter a nursing home, we want care in a small-home environment that's very homelike, noninstitutional," he said. 

Grabowski explained that the pandemic shined a very harsh light on the long-term health care system. 

"Individuals in the community didn't have enough services; we really had to rely heavily on family members," he said.

The large institutional facilities were the ones with the highest death rates. 

"And so what did the pandemic tell us? It told us we really need to push towards expanding care in the community, I think reimagining what nursing homes might be," Grabowski said.

Meaningful Reforms for Long-Term Health Care

David Gifford is a geriatrician and chief medical officer at the American Health Care Association in Washington, DC. Gifford said that the pandemic brought out and magnified the preexisting beliefs and views on the elderly and long-term health care.

He said that he believed that everyone used the pandemic as a platform to promote their preexisting views on what needed to be done in this area.

"I think the challenge is that we, as a society, have not made elderly care and long-term care a priority and that just sort of came through in the pandemic. And the question really is, are we going to make a priority to invest in meaningful reforms, or are we just going to keep sort of doubling down on what we did before, which clearly led us to not be able to respond to the pandemic effectively and efficiently?" Gifford said.

Do Caregivers Earn Enough Money?

Jasmine Travers, an assistant professor and health services researcher at New York University in the Rory Meyers College of Nursing, is an aging researcher. She expressed her concern about caregivers and their compensation. 

"So, when thinking about certified nursing assistants and how much they get paid, an average, $12 to $13 an hour, what does that really actually cover when thinking about their needs -- so, for example, rent that they have to pay per month, or a mortgage, or if it's childcare, if it's food, transportation, for example," Travers said.

Then there is a concern about employee benefits, like health insurance. Travers said some of these positions would have benefits, but the amount of money available for salary and benefits is often limited.

How Do You Pay for Long-Term Health Care?

Since Medicaid is the nation's primary source of long-term health care funding, the amount of taxpayer funds for long-term care has been limited. The amount of funding from health insurance and Medicare is very limited, and not enough people have Long-Term Care Insurance.

Many families self-fund but quickly discover that private pay long-term health care expenses are expensive and have risen sharply in the past few years. The LTC NEWS Cost of Care Calculator shows the average nursing home nationally is well over $100,000 a year. Most private long-term health care is either provided at home or in assisted living; however, that care is also not inexpensive - Cost of Care Calculator - Choose Your State | LTC News.

You can listen to the entire AMA program by clicking here. 

Safe and Quality Care is Always the Goal

Having strict protocols assures the family that their loved one is being taken care of appropriately and safely. No matter if it is a long-term care facility, or in-home caregivers, maintaining quality and safe care is goal number one.

"Providing our caregivers with PPE (personal protective equipment) including masks, gloves, hand sanitizer and even protective gowns when needed is among those protocols," said Dave Bean, franchise owner of Amada Senior Care of Ogden, Utah. 

Dave Bean, Amada Senior Care, Utah

"In addition, Amada caregivers have received trainings and certifications on how to minimize risk to senior clients – and that has been part of our process for all infectious diseases, not just COVID," Bean said.

Many long-term health care providers immediately started to put protocols in place to protect both care recipients and caregivers. Amada was one of the first to create a telehealth process for evaluating caregivers and clients for signs and symptoms of COVID-19.

The goal is to minimize the risk to the care recipients and the caregiver for all infectious diseases.

Longevity and Medical Advances Push Increased Need for Long-Term Health Care

People need long-term health care services due to declining health and mobility problems driven by an illness, accident, or aging. Being prepared before a family crisis starts will reduce the stress and the financial impact. 

The problem of long-term health care is not going away as longevity and medical advances are pushing the envelope. While this can be good news, the flip side of longevity is at some point, we require help or supervision.

"We define progress in this country as 'living longer.' We survive strokes, cancers, and heart attacks. Bottom line Alzheimer's has exploded, not due to contagion but simply because we're lingering longer," said Gene Cutler, a nationally known Long-Term Care Insurance specialist. 

Even though the National Alliance for Caregiving and AARP found that there are 53 million unpaid family caregivers in the United States and the financial devastation professional care (at home or a facility) has on a family's assets, not many financial advisors are pushing for a plan.

An LTC NEWS Survey of Long-Term Care Insurance specialists and financial advisors conducted in April 2022 revealed that discussions about long-term care planning are happening more frequently with their clients today than prior to the virus crisis. However, only 39% percent of the financial advisors who responded said long-term care planning should be a primary goal for their clients. Eight two percent of advisors calling themselves 'long-term care specialists' said it should be a primary goal.

Yet, there has not been a significant increase in the number of clients taking action when compared to numbers before the pandemic.

Increased Consumer Interest in Planning – But Many Wait

While interest in Long-Term Care Insurance has increased, too many tend to ignore obtaining coverage, thinking they can always obtain coverage when they get older. However, according to the American Association for Long-Term Care Insurance, about 40% of those over age 60 will be declined for coverage. The association says that most people start long-term health care planning between ages 52 and 64. 

Many options are available for families to plan for longevity and long-term care. Government solutions are expected to remain in the area of Medicaid. For families with savings to protect, options are only available before a person's health starts declining. 

As the current economic situation with inflation and a stock market decline show, self-funding can be a costly mistake as nobody knows when they will need care and what the economic situation will be at that time.

Research has shown that most people indicate they don't want to place the full responsibility of caregiving on their loved ones. But, if that is their desire, that requires planning before the crisis.

Those who own a Long-Term Care Insurance know they have guaranteed tax-free benefits that pay for all levels of care, including care at home. The top insurance companies paid over $12.3 Billion in Long-Term Care Insurance benefits in 2021 alone.

Preparing Ensures Safe Quality Care and Asset Protection

The issue is more than just money. Access to safe, quality care is a big concern. Care recipients and their families want quality care in the setting they desire. Family caregivers cannot provide long-term health care over long periods of time. 

Long-Term Care Insurance offers access to quality care options, assets protection from the growing costs of these services, and provides time for the adult children to be family instead of caregivers. 

The ideal time to obtain coverage is when you are younger and healthier. Most people get their coverage in their 50s, but the key is to have a plan and ensure safe, quality care and peace of mind for the entire family.