Dad costs Medi-Cal a minimum of $268,800.
As I walked outside into the hot Sacramento summer sun I cried for my father for the first time. How could his only son leave him in a crowded facility, for what I knew, would be his last home. The combination of my abandonment of a man broken by a stroke, the task ahead to care for an ailing mother and the mounting expenses was just overwhelming me. In a perfect world, mom and dad would have had long term care insurance. But when is life either perfect or easy?
It would be another 5 years before my father finally died. How he outlasted my mom I will never know. For the first year we were able to pay for his care after the death of my mother and the sale of their house. Funds exhausted, we had to turn to Medi-Cal to pay the skilled nursing facility costs. At $5600 per month, his liquid assets quickly evaporated.
A conservative amount spent on behalf of my father by Medi-Cal for his skilled nursing facility was $268,800. While the facility was not perfect, I don’t feel they were over charging for the type of care they had to provide to my father. I was perhaps luckier than most as my regular visits gave me the opportunity to become acquainted with most of the day, evening and weekend staff. They always kept me informed of his status.
By any measure, dad would have outlived the benefits of most modest long term care insurance (LTCi) plans. When the average skilled nursing facility is 2 1/2 years, dad managed to spend 5 years in residence. I would visit him 2 to 3 times per week making sure he was as comfortable as possible. My mother died shortly after my father went into permanent residence at the skilled nursing facility. I was able to grant her wish to die at home.
It was with great sadness that I read the CLASS initiative ( Community Living Assistance Services and Supports) of the health care reform legislation, PPACA, was abandoned in October of 2011.
Administration Nixes the Class Act
The Obama Administration on Friday announced that it was scrapping the Class Act, the government-run insurance program for long-term care authorized by the Affordable Care Act, essentially because the numbers could not be made to work.
The targeted premiums would not keep the program solvent over the long term. Wow, sounds like the program was mirroring real life. The state of our health care keeps people out living their resources. The result is a huge shift of older Americans forced into long term care facilities funded by state governments.
This is unfortunate because as you can see from my father’s experience, skilled nursing facilities can chew a hole in any budget. At least with a modest amount of LTCi, it would ease the burden from the government budget. The present market situation allows for wealthy people to protect their assets with LTCi while shifting long term care costs of middle and lower wage earners onto the government.
Long term care insurance, from an insurer’s perspective, is usually marketed to people with significant assets to protect. The theory is they can afford LTCi and want to protect their inheritance. Insurers have, at times, discouraged people of modest means from purchasing LTCi because the prevailing philosophy is that Medicaid will pick up the skilled nursing facility cost. This position adds to the swelling public debt and entitlements. The people who need LTCi the most are folks of modest means so they don’t add to the public debt burden. America needs to approach long term care from a community perspective not a marketing standpoint.
Lower and middle wage earners do not have the discretionary income to purchase LTCi. It is easier to sell LTCi to high wage earners who are motivated not only by insurance for LTCi but also to preserve assets. Some folks are fortunate enough to get into a small or large group employer participation for long term care insurance which can be more affordable.
The CLASS program was meant to address the wave of retirees coming in the next decades and the anticipated costs of long term care to state and Federal budgets. Those who advocate against CLASS, and for the status quo, are hypocritical in that they want to cut government spending but will ultimately be responsible for greater public debt as more frail and elderly people are pushed on to Medicaid. Their response to the very real problem is shorted sighted. It is particularly ugly that insurance companies and agents against CLASS, or any government program, openly acknowledge that folks who can’t afford LTCi are not part of their market because there are government programs to take care of them.
I will never be able to repay Medi-Cal for a level of care my father received. I am eternally grateful for the Medi-Cal program. I am fairly certain that no one wants to go into a skilled nursing facility and their friends or relatives don’t want them to either. Unfortunately, it is a fact of life. Doesn’t it just make sense to create a program to voluntarily allow people to get some LTCi even if it is a modest amount? This is just too important to give up on.
Mr. President, Congress, and the Department Health & Human Services, please keep working on a solution, our elderly and government budgets depend on it.
Addendum: comprehensive article on the challenges faced by CLASS, long term care Americans.
Demise of Obama long-term care plan leaves gap
By RICARDO ALONSO-ZALDIVAR, Associated Press
