About the Long Term Care Benefits in the Health Care Bill
(Warning: This post is going to be controversial and expresses my views only.)
Both the House and Senate bills would create a voluntary federal program to provide long-term care insurance that pays small cash benefits to people with severe cognitive or physical disabilities. Like the elderly.
I don't think most people understand what long term care insurance covers. It covers nursing homes, assisted living facilities, and for the cognitively or physically disabled, some home health care costs in lieu of going to a facility. This isn't medical coverage but coverage that assists those who can't feed, clothe, toilet or bathe themselves. You aren't eligible until you can't do at least two of the above. The payments cover a fraction of the actual cost of the services. In other words, you have to be basically physically or mentally dysfunctional to qualify for what is a paltry amount of benefits. [More...]
I have spent enough time in assisted living facilities and nursing homes (both of my parents died in them, one in a rehab unit and the other after three years in a nursing home preceded by three years in assisted living) to know I have no intention of going to either. When the time comes that I can't feed, dress, bathe and toilet myself, I'm checking out. I canceled my long term care policy years ago, I'm just not going.
There is something seriously wrong with a system that shuttles the old and demented to a nursing home where they will die at an average cost of $10,000 a month. Most long term care policies pay between $75 and $200 a day (the rest of the expense is not covered by Medicare or private insurance.)
What do you do there besides wait to die while suffering indignities like being diapered and wheeled from the dining room to your room and back, to eat among strangers you can't communicate with even if you wanted to? The odds are one or both of you will not make sense due to dementia.
Even if physical therapy could help you, Medicare gets it seriously wrong. They will pay for therapy until you have reached "a peak" where they acknowledge you've gotten as far as you can. So if your head falls into your chest when you sit in your wheelchair, and they finally get you to where your head stays semi-up, they say that's as far as you will go, and Medicare cuts off your therapy. (You then are eligible for restorative therapy which consists of a nursing home staffer coming in your room to offer to wheel you around the facility once a day.)
Even if you offer to pay for continued therapy with your own money, they won't continue the therapy. They say they don't have the staff available -- their therapists are needed for those who haven't yet reached "their peak."
You then have to wait until you've lost the gain from your therapy to the point where your head is back on your chest, usually about three months, before they agree to start all over again. And then, the cycle repeats. They finally get you to the same point as before, but when you reach the peak, you're done.
Same for walking. You can get therapy to get you out of a wheelchair and walking down the hall, but once they have you walking for a few minutes, and that's likely as far as you are going to be able to walk on your own, instead of continuing the therapy so your legs don't atrophy, they have to stop the therapy. A few months later, when you're back to where you started and no longer able to even stand up when getting from the bed to the wheelchair, they'll start in again -- until you're walking for five minutes, held up by a harnass, and then, you've reached your peak and the therapy stops. In other words, you lose all the benefits of the therapy and they wait months, then repeat from scratch. The off-months are miserable for the patient, and a total waste.
Long term care benefits are a rip-off. I'd rather see the money go to counseling for end of life decisions, and laws that allow the physically and cognitively disabled who had the foresight to sign an end of life directive while still cognitively able to do so, make the choice to end their life when it comes to that -- rather than forcing them to use their life-time accumulation of assets (again, at $120k year up) to live without dignity, without quality of life, sedated into oblivion by anti-psychotic drugs so they won't make a fuss and be disruptive among other patients and strangers (whether at the nursing home or at home with part-time home health care workers) until they die.
Memo to Congress: Keep your lousy $75 a day benefit. I don't want to pay for it and have no intention of using it. Instead, expand Medicare benefits to cover the full cost of assisted living facilities and nursing homes for those who need and are willing to go, and allow the rest of us to opt out through a dignified death -- meaning we are allowed to obtain prescriptions for drugs in sufficient quantities that will allow us to implement our decision to opt-out -- without fear of criminal prosecution should we fail.
The money the Government saves from the opt-outs should be enough to allow it to change those crazy policies that cut off therpay coverage when a patient is functioning at their maximum level. The whole point should be to keep patients at their maximum level of functioning, and that can only be done with continued therapy.
This isn't the fault of the nursing homes or assisted living facilities. It's the fault of the Government, for enacting its crazy hodge-podge of regulations and limits related to providing physical and occupational therapies.
I don't see how $75 a day is going to get qualified health care workers to anyone's house to do what's needed. It's a drop in the bucket. A frank discussion with our elders about what they prefer should they find themselves in that circumstance is what's needed, and in order for that to be a meaningful discussion, there must be meaningful choices available.
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