In an recent article in The Boston Globe, "As costs mount, states scramble for new ways to pay for late-in-life care," reporter Robert Weisman describes initiatives in states around the country to pay for the growing costs of caring for seniors around the country. While the average cost of care for older Americans will be $266,000 according to one projection, only 7% of Americans over age 50 have long-term care insurance. This huge gap falls both on individual families and state Medicaid programs, MassHealth in Massachusetts.
With no solution coming from Washington, to fill at least some of the gap, state initiatives include:
- Washington state has a new fund financed by a 0.58% payroll tax that provides up to $36,500 to pay for long-term care costs, whether for retrofitting an existing home or paying for nursing home care.
- Hawaii provides family caregivers who work at least 30 hours a week outside the home up to $70 a day to help pay the costs of caring for family members while they're at work.
- Other states are working to increase the pay of home health aides. The need for this was expressed in a letter to the editor by the executive director of the Home Care Alliance of Massachusetts, pointing out that home care is both one of the fastest growing and lowest paid job in the United States.
On the other hand, a more ambitious program to provide free at-home services in Maine with a 3.8% income tax was defeated in a referendum by 63% of the voters.
What About Massachusetts?
Massachusetts is taking a wait-and-see approach. "We're learning from what others are doing," according to Secretary of Elder Affairs Elizabeth Chen.
That said, during the Deval Patrick administration MassHealth did expand to cover assisted living and home care under certain situations. The problem is that the options and eligibility for them are both very complex and not all available either throughout the state or in every assisted living facility. This makes planning very difficult for families, given both the many moving parts and the fact that their loved ones' needs tend to change over time.
What Should We Do?
In terms of public policy, I've long felt that we need universal long-term care insurance, perhaps a Medicare Part E, that would provide basic long-term care funding for everyone paid for by everyone. Perhaps it would provide a certain dollar amount of coverage that might be used in any setting, with different limits for home care, assisted living and nursing homes. Families could supplement this basic coverage out-of-pocket, with long-term care insurance or through Medicaid if they were to run through the funding completely.
Absent such a comprehensive program, we rely on Medicaid with its restrictions and complications. It helps keep elder law attorneys in business, but we're only filling in for the absence of a public policy solution.