Thursday, October 3, 2013

Documenting Confusion Over Paying for Long-Term Care: Who is Most Confused?

A new Harris Interactive/HealthDay Poll finds that "more than two-thirds of Americans are anxious and uncertain about how they'll meet nursing home or home care costs should they need them."  Fair enough.  Plenty of good reasons for such anxiety.

However, in summarizing the poll results, the Harris folks also conclude:

"Most people were also wrong about how most of these costs are covered under the current system. About half (49 percent) mistakenly thought the bulk of the bill was paid by individuals, while one-third guessed Medicare.  Only 19 percent understood that the major funder of long-term care is actually Medicaid, the government agency that covers health services for the poor."

But were those people actually "wrong?"  Perhaps it depends on what you mean by "long-term care." If you are viewing that care as provided by paid individuals, whether in the home or in a facility, then the Harris poll's conclusions accurately point to Medicaid's continuing role as a dominant payment source.

But in the US the largest source of elder care is still the family, as documented by AARP Public Policy Institute's 2011 Update.  Even though family members are not usually "paid" for the care with dollars per hour, there is a cost associated with that care.  For example, famly care-givers are often unable to engage in other paid employment, or take time off from careers to assist with elders.  And thus, perhaps interviewees for the Harris poll were correct, because they were thinking about the realities of families assuming the costs of long-term care.

In other countries, a distinction is often made between "health care" and "social care."  What we call "long-term care" in the United States tends to lump these concepts together, while the most frequently needed services, such as assistance with bathing, dressing, meals, monitoring for safety  or supervision with other activities of daily living,  would often be characterized as social care in other countries.  Caution is necessary in using labels to characterize the cost of care for older adults (or for any individuals needing assistance).   

Additional thought on using labels to characterize types of care and care-givers is provided by The National Care Planning Council.

Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid | Permalink

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Another area of confusion is the use of the words “Home Health.” Many LTC insurance policies provide benefits for in-home custodial care and the policies' language uses the term “Home Health.” But “HH” to the provider community means the per-doctor’s-orders, in-home skilled care and/or rehab, NOT custodial care. Hence, many people hear “Home Health” is paid by Medicare and extrapolate the thinking to “custodial care.” Another thing: the government didn’t do the public any favors by picking the monikers “Medicare” and “Medicaid.” Many people use these terms interchangeably and don’t know the difference! Also, when the Medicare Supplement (Medigap) industry was standardized decades ago (back then: Plans A – J), why in the world they chose to use those alphabet letters, when Medicare itself already had Parts A and B. Ah, the government … keep it up and confuse people more.

Posted by: Jennifer | Oct 4, 2013 12:16:57 PM

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