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Long-Term Care Financing Must Be Part of Health Care Reform
Date:7/9/2009

ensive long-term care that a young adult with a disability may need.

Nearly 70 percent of those who turned 65 in 2005 will need some long-term services. The average time: three years. Contracting with a home aide just three days per week for 2-3 hours at a time to provide basics such as meal preparation and help with dressing can easily cost $1,000 to $2,000 per month. Nursing home care is much more expensive. The average annual cost for a private room in the U.S. is more than $75,000.

The status quo means many will continue impoverishing themselves and turning to Medicaid - a government program and de facto long-term care provider. Primarily paying for institutional care, its "payments" already fall far short in meeting true costs. Without financing reform, we're simply cost shifting and avoiding the main issue - finance reform for longevity and chronic care.

For example, it's expedient to say that families should provide more care. But most families can't afford to or they impossibly juggle between care giving and their other full-time job, shortchanging both. Another expedient approach is simply cutting Medicaid further and reducing such things as at-home services. But that contributes to a more expensive volley between home and the emergency room.

Our country's overriding goals should be empowering people to live in the most independent setting possible; transforming nursing homes into right-sized, very specialized chronic care centers that contribute to a well-coordinated lifetime of care; taking a personal share in costs of chronic care and supportive services; and ensuring a strong safety net for people who never will be able to pay for such care and services.

If America were creating a chronic care system today, we'd never make Medicaid the primary payer. We'd never require people to impoverish themselves to get coverage. And we'd never rely simply on hope, hope that people would purchas
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