The Crisis in Long-Term Care

Baby boomers and their families need to plan now for the inevitable cost of long-term care and for their roles as care givers. 

A woman in yellow cardigan talking to an older man

There were unspeakable scandals during the COVID-19 outbreak among certain nursing homes and veteran hospitals in New Jersey. 9,000 patients died in nursing homes, and 2,000 died in veterans hospitals during the pandemic. Two facilities were suspended from the Medicaid program and forced to close or sell to new owners, and the state is continuing to crack down.

Just recently, a long-term care facility was found to have serious health and safety violations that led to the death of seven residents from COVID-19. An additional 66 residents and staff members were infected. A patient died after waiting for days to get the antiviral medication prescribed for treating COVID-19. The state halted admissions in November until a new owner could take over.

In New York, a recent state health inspection gave a long-term care (LTC) facility one star, far below average, for not preventing the spread of COVID-19 and for dangerous falls and broken bones. 

A long-term care ombudsman in New Jersey recently stated, “There should be no question about the health and safety of long-term care residents.” I could not agree more.

Aging baby boomers like me will drive the long-term care crisis. Currently, there are 14 million people in the U.S. receiving some form of long-term care. That number is expected to double by 2050. This growing number of people who will need support and services will result in a major burden on their children and families. A substantial number, roughly 25%, will need “severe care.”

Medicare and private health insurances generally do not pay for long-term care, other than for recovering from acute health problems. The Medicaid system is only available to people who have exhausted their financial resources to under $2,000. There is no national solution on the horizon, and for now, it is up to individuals and their families to solve this evolving crisis.

See also: The Staffing Crisis in Insurance

The crisis will only escalate, as 70% of people over 65 will need some form of long-term care down the road, such as assisted living or nursing homes. Research shows that 45% of baby boomers have no retirement savings, and only 25% have more than $100,000 in savings. The average cost of a long-term care facility is $100,000 per year, which will wipe out most retirement plans.

The impact of the long-term care crisis is parallel to that of the caregiver crisis, which is staggering. As a caregiver for my mom, dad and now my older brother, I had to learn on my own how to deal with power of attorney, healthcare proxy, Medicaid, Medicare, their finances, Social Security, pensions, living wills, taxes, selling a home, healthcare directives, DNR (Do Not Resuscitate) orders, doctor appointments, visiting nurses, prescription medications, surgery and slips and falls, just to name a few.  I also had to become an expert in congestive heart failure, diabetes, transitional delirium, dementia and depression. 

There is no way to prepare oneself to become a caregiver. It will be the toughest job you have ever had, and you have no choice. Your job and life become secondary, or just a welcomed diversion. One night, I got a call that both my mom and dad were on their way to the emergency room in two different ambulances at the same time. The only good news was that they were going to the same hospital.

Two years ago, I got a call that my brother was in intensive care for a week before they found my healthcare proxy in his medical records. He had a blockage in his colon leading to both sepsis and pneumonia. This caused development of encephalopathy, referring to overall brain dysfunction, which was hallmarked by his transitional delirium. He was hallucinating and seeing things like gorillas climbing up the tree outside his window.   

After several months in intensive care, he was discharged to a nursing home. I had to fight tooth and nail to get him on Medicaid so that he could be treated in a long-term care facility. The nursing home was a nightmare; he was found lying on the floor unattended and ended up back in the emergency room with internal bleeding. He almost died.

From that minute onward, I dropped everything and saw to it that he received the finest medical care available to him. The situation became even further complicated when I discovered that $10,000 was stolen from his bank account by a roommate while he was in the hospital, leading me to need to file criminal charges. The entire situation epitomized a living nightmare.

See also: The Future of Caregiving

The moral of the story is that we are facing a crisis in both long-term care access and caregiver responsibilities. Baby boomers and their families need to plan now for the inevitable cost of long-term care. The Centers for Medicaid and Medicare has created a five-star rating system for health inspections, staffing and quality measures. That is a good place to start.

The need for long-term care insurance is staggering, yet long-term care coverage has been declining for years. Major insurers have pulled out of the market due to complete lack of understanding of the need, as well as associated costs. Research shows that only 3% to 4% of Americans over 50 have a long-term care policy. It is estimated that 70% of people 65 and over will need critical services in the near future.

The current political environment shows little, if any, hope for long-term care solutions. It is up to individuals and their families to speak to qualified and licensed professionals who are experts in their field to help determine their options and needs.

Daniel Miller

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Daniel Miller

Dan Miller is president of Daniel R. Miller, MPH Consulting. He specializes in healthcare-cost containment, absence-management best practices (STD, LTD, FMLA and workers' comp), integrated disability management and workers’ compensation managed care.


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