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Planning for Aging Is a Necessity

How can Congress improve long-term care for aging Americans?

Modern medical science has made tremendous strides in the past century. Groundbreaking research has led to cures for formerly fatal diseases, improved care for the terminally ill and increased the life expectancy of most Americans.

Yet, these great accomplishments also have brought new challenges. Medical advancements that improve longevity, coupled with a large aging population, have raised new questions about long-term care for the elderly and disabled — especially about who will provide it and how it will be paid for.

Presently, there are nearly 10 million Americans in need of long-term care services. As the number of U.S. citizens over age 65 — those most likely to need long-term care — doubles in the next 30 years, demand for services will increase dramatically. We must meet this growing need in a comprehensive manner.

Ideally, any good plan should aim to meet the overarching goals of: allowing individuals to age in place; promoting the highest quality of life for people with long-term care needs; improving individuals’ ability to care for themselves; encouraging personal financial preparation for long-term care; and supporting caregivers.

Currently, unpaid family caregivers supply the bulk of long-term care. According to the Administration on Aging, an estimated 22 million Americans are providing uncompensated care. Yet, the supply of these family caregivers is shrinking, leaving many elderly citizens to rely on a health professional for their care. The cost of replacing these informal caregivers with professionals is estimated to be from $50 billion to $103 billion annually.

Unfortunately, there also is a shortage of paid caregivers. Every year the pool of available nurses and home health aides seems to grow smaller, setting our nation up for a potential long-term care crisis. I believe one important way to improve long-term care is to provide incentives to our young people to enter worthwhile professions, such as nursing, that provide care to older Americans.

An increase in these professionals will help us allow individuals to age in place. Research has consistently shown that it costs significantly less to provide care to an individual in the community as opposed to an institution. We can help older Americans remain in their communities through the provision and coordination of supportive services such as case management, case assistance and social work services; health care management and health care assistance (including disease prevention and health promotion services); and education, socialization and recreational activities.

Improving an individual’s ability to care for himself or herself also holds the potential to reduce the need for long-term care services and costs. We can help Americans stay independent through the promotion of preventive care and wellness measures. Often the need for long-term care is a direct result of chronic conditions such as diabetes, stroke or heart disease. Encouraging Americans to take steps to improve their health today through diet, exercise and routine physical examinations could go a long way to improving a person’s ability to remain self-sufficient tomorrow.

We also must encourage individuals to plan financially for their long-term care needs. Currently, too few Americans are adequately prepared for the possibility that they will need long-term care services during old age. Many people wrongly assume that Medicare will cover all of their long-term care needs, when it does not. This leaves them with fewer options in their time of need.

Congress should highlight the importance of saving for long-term care. There is the potential for the long-term care insurance market to play a positive role in this. However, before we encourage Americans to enter the long-term care insurance market, we must make sure they have access to affordable products that include strong consumer protections applied uniformly across the market.

Often though, the need for long-term care overwhelms many Americans, regardless of their level of preparedness. When they cannot meet the financial costs, our government must step in to ensure that our citizens receive the care they need. The U.S. government currently spends approximately $194 billion annually on long-term care services — comparable to our spending on prescription drugs — and the costs are growing at 7.4 percent each year.

The largest payer within the government for long-term care services is Medicaid, which pays nearly half of all long-term care expenditures. We must continue to offer this program as a safety net for individuals who are unable to afford long-term care services on their own.

Although the budgetary impact of long-term care is daunting, it is crucial that we not “gut” the Medicaid system, forcing low-income families out of the program with nowhere to turn. This only leaves our doctors and hospitals with mounting bills for the uncompensated care they are required to provide.

I believe it is fair to say that our nation is aging rapidly without a coordinated policy on long-term care. This simply cannot continue, but any proposed solutions to this complex and changing situation will undoubtedly come up against the budget challenges our government currently faces.

Congress must act to encourage personal decisions about careers in health care and acquiring insurance, while still providing assistance to our most vulnerable citizens. The best proposals will find a way to ensure the compassionate, comprehensive care our citizens deserve, while also addressing the enormous costs currently associated with providing that care.

Rep. Frank Pallone (D-N.J.) is chairman of the Energy and Commerce subcommittee on health.

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