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Long-term care hits a nerve for many PDF Print E-mail
Written by Wauneta Breeze   
Thursday, 07 May 2015 20:53

Editor’s Note: The Rural Health News Service is funded by a grant from The Commonwealth Fund and distributed through the Nebraska Press Association Foundation, the Colorado Press Association, the South Dakota Newspaper Association and the Hoosier (IN) State Press Association.

By Trudy Lieberman

Rural Health News Service


Readers have been offering feedback to Thinking About Health columns.  But never has a column inspired more emailed messages than the one I wrote in March about private long-term care insurance and the lack of a national system to pay for nursing home and community services for the country’s aging population.

And once again, the emails illustrated the pickle families find themselves in.

Marty Callahan who edits the Greeley Citizen in Greeley, Neb., told me in his area “costs are escalating at nursing facilities and more and more of my readers are entering facilities at alarming levels as Medicaid residents.” That means those families had no money to pay the nursing home tab which in Nebraska now averages $72,000 annually for a semi-private and $80,000 for a private room. This topic “is getting far too little attention,” Callahan said, adding, “This is, indeed, going to be the next healthcare crisis.”

Other emails offered more evidence.

One woman in Burlington, Colo., told me about her mother’s Medicaid spend-down to pay her nursing home bills. Her mother had worked hard on the farm and supplemented the family income working in restaurants, cleaning houses, and as a caregiver. She spent “very little” of the $50,000 left over from the farm sale, and continued to work. At age 89 she broke her hip. Cooper said, “It was a gradual downhill from there.”

Eventually she went to a nursing home, and the family paid the bill from the $50,000 cashing out the CDs when the bills came due. When that was gone, she went on Medicaid, and the facility moved her from a small private room to a shared room. In the end she had less than $2,000 in the bank plus her car.

The woman says the real tragedy was that her mom could not understand why she had no money. She would call the banks and ask where her money was. “I told them to make up a reason,” she said. “How do you tell someone who sacrificed her whole life for others that she didn’t have her money to spend in the end?”

One email from a 63-year-old man in Jacksonville, Ill., described an all-too-typical predicament—Premiums for policies he and his wife bought when they were in their late 50s were rising so high they could no longer pay them. Last year they went up 83 percent. He said he had to shorten the annual benefit and the number of years the policy would pay in order to keep it in force, hardly an ideal solution. He says he will probably drop the policy in the next couple of years, another bad solution. The carrier said to expect another rate increase in 2016.

An 81-year-old woman from Rome City, Ind., wanted me to know that the monthly premium for a policy she bought for home care 19 years ago had increased from $60 to $124, but she would not drop the policy because she couldn’t afford the cost of a new one. “I do have to say that having this policy has given me some peace of mind,” she wrote.  She wants care at home, and the policy will pay for some of it. But if she needs a nursing home, she may have to go on Medicaid like thousands of other Americans.

I turned to Bonnie Burns, a national long-term care expert who also works with California Health Advocates. These emails are typical, she said. Most people spending down are just short of being considered low-income, and “they exhaust every little bit they have.”  As for the larger thread running through them, it shows “we leave it up to every single family to figure it out on their own.”

Burns has spent the last two decades trying to improve long-term care insurance in California, a state that has been a leader in consumer protection standards such as reforming home care benefits and “three serious attempts to regulate rates.” The intent, she explained, “Was to prevent the large rate increases we see today. All three have failed.”

Legislation on the table in California would create a task force to consider the feasibility of a statewide long-term care program. It would examine everything from fragmentation of services to payment.

California may well lead again, but it might take collective voices from across the country to effect change. Tom, a reader in Ridgeway, Colo., suggested “a lot of us are going to have to make a lot more noise if we’re ever going to see any movement toward a more decent, humane, and affordable (end-of-life) strategy for the elderly.”

We’d like to hear about your experiences with end-of-life issues.  Write to Trudy at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

TRUDY LIEBERMAN is a contributing editor to the Columbia Journalism Review where she blogs about health care and retirement. She is also a fellow at the Center for Advancing Health where she blogs about health.