Long-term-care system critically in need of help
It encompasses several mortal sins of ineptitude and bureaucracy: insensitivity, ineffective enforcement and poor stewardship of taxpayer dollars.
But let's be honest. Government's approach to the issue is not unlike that of its constituents. Frailty and dementia make us uncomfortable. We are sympathetic for the afflicted and their caregivers but relieved that it is not our burden to bear. Just send us the bill.
Long-term care has few champions. David Stevenson, a Harvard Medical School professor, noted in a recent edition of the New England Journal of Medicine that health care was mentioned more than 1,000 times during the 35 Democratic and Republican debates during the primaries. But almost nothing has been said about LTC, despite the fact that it comprises about 10 percent of health care spending.
LTC is more about social functioning than managing disease. The estimated 9.5 million Americans who require LTC need assistance with at least one activity of daily living (bathing, dressing, eating, toilet use and moving from one room to another) or instrumental activities of daily living (meal preparation, money and medication management, telephone use, light housework and food shopping).
But as we — and government — avert our eyes, bad things are happening. Back to those government mortal sins.
Insensitivity
Much of LTC is given for free — by unpaid and untrained spouses and children. There are an estimated 16 million working-age adults caring for sick or disabled family members, according to the Commonwealth Fund Biennial Health Insurance survey. Of these, 9 million have their own health problems. Women comprise two-thirds of the caregivers. These caregivers disproportionately come from lower-income households and lack insurance, and 60 percent report problems with medical bills or medical debt.
The annual out-of-pocket cost for a family caregiver is $5,500, which is more than the average U.S. household spends on health care and entertainment combined. Providing such care is a heavy burden in physical, mental and emotional pain. Sixty-two percent of caregivers must alter work schedules, and the resulting lost productivity costs employers $29 billion annually. Between 30 percent and 59 percent report depressive disorders or symptoms. At least half suffer feelings of isolation and being overwhelmed by the burden.
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Having met Bill Bonn, who is an architect involved in licensing a…
arc | July 6, 2008 at 8:31 a.m.
