Should a single payer healthcare plan cover nursing home and/or assisted living?

[NNguyenMD]

I can only speak for myself, but I will admit that as a healthcare provider, I am very naive when it comes to how much it actually costs patients for long term nursing care.

The question I pose to DUer's familiar with the cost of having someone live in a nursing home or in assisted living is, "Is longterm residential care something that should fall under a single payer, universal healthcare plan in addition to doctors visits, prescription drugs, and hospital stays?"

From my limited understanding, many of those who live in assisted living now end up selling their homes to move into these places. To me, that is a tragedy that someone who has work their entire life to pay for their house must now sell it in order to get the daily care they need for a reasonable quailty of life.

But I guess an even more compelling question is, should fellow Americans pitch in to help that person get assisted living so that they and their children don't go bankrupt paying for nursing care.

[Rhythm and Blue]

1. Certainly. I can't imagine why any medically-necessary care would be denied. nt

[gateley]

2. I would hope so and fight for it. nt

[TahitiNut]

3. Yes. Home care and hospice care, too.

It's essential that a full (and continuous) range of care options are covered with a small copay for those with an ability to pay WITHOUT forcing liquidation of home, car, and personal assets. When people have their homes confiscated, the toll is horrendous. When their total savings are wiped out, it leaves them with no ability to deal with other emergencies. Thus, savings up to about $75K should be left untouched, imho.

[pnwmom]

31. Isn't hospice care always covered? I think the typical problem

is that doctors are reluctant to prescribe it, because it appears to mean they've given up on the patient. But hospice care is covered by Medicare as long as a doctor certifies his/her opinion that the patient has 6 months or less to live (and this can be re-certified when necessary, if the patient lives longer than expected.)

I wouldn't have a problem with some amount, such as you suggest, being left untouched. But I don't think it's reasonable for the taxpayers to pay the costs of people who can well afford it, just so they have more to leave to their adult children.

[Liberty Belle]

4. Yes, absolutely! My parents are going through this nightmare now.

Dad has Alzheimer's and Parkinson's. After multiple hospitalizations it's clear Mom can no longer care for him at home, especially since she is showing signs of early stage Alzheimer's herself.

Dad is now in a nursing home. But we are horrified to learn the costs, and that the "long term care" insurance Mom bought through AARP is next to useless.

Here are the horrifiying facts of life for old, sick people in the U.S.:

Medicare covers the first 21 days of "rehab" at 100%.
After that, from day 21 to 100, if you can get a physician to extend the prescription for rehab, you have to pay $124 out of pocket--per day.
AARP will pick up a maximum of $100 a day, for no more than $1700 a year.

Trouble is, after the 100th day, you're stuck for the full bill, which runs about $4,000 to $6,000 a month for Alzheimer's patients in long-term care. Some higher end places are as much as $8,000 a month. This is NOT optional - without full time care, Alzheimer's patients with no one able to care for them at home would be out in the streets!

To apply for MediCal in California, you can own only a home and a small amount of money in the bank. Don't bother trying to sell off assets or even give them to your kids. If you've done that within the past 3 years, you wlil be accused of trying to scam MediCal. You can give away up to about $10,000 a year, but that's it.

So everything that mom and Dad spent a lifetime saving will be gone in months--and Dad could linger on for years. Then what if Mom needs long term care?

This is a national nightmare - degrading to our elderly, terrifying for our generation. With two parents and two grandparents who have/had Alzheimer's, I dread what the future may hold in store for me and my children, especially if we don't get national healthcare soon.

I believe that all people should be entitled to free long-term care if they are too sick or mentally disabled to live alone or if family is no longer able to care for them. We have shelters for cats and dogs, yet force our elderly to give up their assets along with their dignity if they need care. This is wrong!

Please write your Congressman today and urge that long-term care be included in any national healthcare policy.

[rumpel]

6. absolutely agree

and Medical (Medicaid) has a provision that when a covered person dies, they could recoup all the costs Medical expended on them...

[pnwmom]

8. I agree that one spouse shouldn't be left with no assets because the first

one required this kind of care.

But I don't agree that taxpayers should pay for free long term care of the disabled, no matter what his or her assets, just so that children have something to inherit some day.

[terisan]

43. i agree. nt

[Gormy Cuss]

51. That's really what it's about.

Seniors want to be able to leave something to the next generation and also don't want to admit that a long term care facility IS their home.

That said, I also recognize that we have a very warped approach to assisted living and long term care. Most seniors who need assisted living could manage in their own homes if we had a visiting nurse/home health aide system that was more comprehensive. In some parts of Europe this is the approach because it is far more cost effective. Even for people who need more intensive nursing care we could improve the options available by recognizing the value of family care with supplemental supports. People tend to stay healthier and more engaged the longer that they can stay in their familiar surroundings. Congregate care facilities should really be the option of last resort.

[pnwmom]

60. I was wondering how they do it in Europe.

And I agree that it's better to stay in familiar surroundings as long as possible. My mother-in-law finally had to move close to us because she had no one nearby to help her, but my mother lives near one of my siblings, and we're determined to keep her in her home as long as possible.

For people who qualify for Medicaid nursing care, in-home assistance can be provided by relatives. A friend of mine took the required training and brought her mother into her home, with a small salary provided by the government (the government encourages this because it saves a lot over the cost of nursing home care). Since her mother died, my friend has cared for another elderly woman, for a significantly higher salary.

[SharonAnn]

109. I agree. We save in order to take care of ourselves and our dependents.

Children are not entitled to inherit their parents' assets, especially by getting other people to pay for their parents' care.

[lapislzi]

126. OK, so at what point would a senior quality for free or subsidized care?

How destitute is destitute?

I guess you're not in favor of Social Security either. Why should we get other people to pay for our retirement?

And I won't even ask your opinion of universal single payer health care.

I guess I bilked the system because I followed my father's wishes and put some of the proceeds from the sale of his house into an account for my daughter. I should have let the for-profit nursing home take it all. I guess I should undertake to repay the state for the money it spent on my father's care. Mea culpa. Or maybe I should just pay you directly; that would be simpler, wouldn't it? Who do I make the check out to?

[question everything]

14. This is not "long term insurance"

$1700 a year is nothing. Mine is $150 a day for 10 years. And the amount will adjust to inflation if and when I need it.

And, yes, it is expensive.

[Yupster]

49. Look into buying long term care insurance everyone

and do it before you hit age 60.

You can get a decent policy for to people for $ 225 a month or so at that age that will cover nursing home, assisted living and home care. It won't be cadillac coverage, but it would be a major help.

Millions of people are buying it each of these last few years because they know how much it costs them for their own mother's care.

[CountAllVotes]

81. good luck buying long term care insurance

if you have a solitary thing wrong, you will most likely be denied.

:puke:

[Lars39]

42. They can now go back 5 years, to look for "gifts. :^(

[CountAllVotes]

80. my husband's sister just got dumped into a nursing home

cost = $8,000.00 a month. His family has a long life span too. She could easily live another 10+ years and will be flat broke by then after they sell her house. :(

:argh:

[robinlynne]

188. My Mom has alzheimers, but is still ok, and a friend warned me that we can all

lose everything, when we can't take care of her any longer.

[pnwmom]

5. I don't think that costs that are basic living costs -- as opposed to medically

necessary costs -- should be covered.

When we looked into assisted living for a relative, there was a basic "retirement" living cost, for living in the apartment and dining in the dining room. Why should Medicare, which is already sinking under the weight of rising health care costs, have to be responsible for living expenses of everyone over the age of 67 who needs some extra care?

I think there could be an argument for Medicare to pay for the "assisted" part of assisted-living -- but not the basic living cost -- especially for people who own houses and other assets that could be sold to pay for retirement living. Why should taxpayers pay for basic living expenses of relatively well-off seniors, so that the seniors will have paid-for houses to leave to their children in their wills?

[TahitiNut]

19. There should then be coverage for such care in one's own home.

Home care is an essential option in any spectrum of coverage, imho. One or two visits per day by paraprofessional people, each visit lasting 1-2 hours, is perfectly adequate for many people with limited mobility. People typically need some assistance with laundry, cleaning, bathing, and some cooking. Meals on Wheels is an outstanding organization in this area - staffed by volunteers and funded by 'voluntary' payments and government subsidies. They deliver one hot meal and one cold meal on regular weekdays. Such a service should, imho, be expanded for those needing it.

[pnwmom]

28. I think there are policies that provide for those services.

I remember my mother-in-law talking about her policies, and I think they cover assisted-living services whether in a facility or in her own home.

Still, she prides herself on never having used them.

[cuke]

122. The two of you don't understand

Having a nurse come in for an hour or two is not long-term care. Medicare and most insurance (non-long-term care) policies will pay for that so long as it's "medically necessary"

If the patient is immobile, having someone in for an hour or two is not sufficient. What about going to the bathroom. What about exercise of some sort? What about socialization? What if there's a fire, a broken pipe, or some other emergency?

My mom has Alzheimer's. She can't survive independently. She needs to be watched 24/7. There are thousands and thousands like her. To have someone (anyone) come it costs at least $15/hr. Multiply that by 24 * 7 * 52 to get the yearly expense of $131040. Multiply that times 5 because Medicaid has a 5 year look back period for a total of $655200. Or you can put them in a nursing home for a minimum of $70k/yr, which doesn't include many expenses. Over 5 years, that's $350k minimum.

Now imagine someone who has some assets, like a home, but not enough to pay for all that. Medicare won't pay for it because they have assets of their own. So they sell the home and use the proceeds to pay for care. But what happens when the money runs out?

[SharonAnn]

162. Then Medicaid takes over.

[cuke]

164. Pay attention

Medicaid has a 5 year "look back" period. If your money only lasts 3 years, who pays for the last two years of care?

[bobbolink]

187. You seem to be thinking of those who have families.

Not everyone is so fortunate.

Although I'm more and more of the same mind as you concerning "well-off seniors".

Actually, to tell you the truth, what I wish now is that people who vote Republic and vote for all these cuts shouldn't be eligible for assistance at all. Let 'em learn the hard way.

Yeah, I know.. that' isn't very "christian" of me... but I'm so sick of the two-faced crap I see waaaay too much of.

[SeattleGirl]

7. Absolutely.

My mom is currently in an assisted living facility, while she finishes getting a course of antibiotics. I don't see it as any different, bottom line, than someone who needs to be hospitalized

[pnwmom]

9. My mother in law is living in an assisted living facility,

where she pays at the "retired," non-assisted rate.

I don't see it as much different than living in an apartment anywhere, except that there is a dining room downstairs whenever she wants it. Why should the government pay for her basic living expenses? She has assets, and she should spend them to take care of herself -- not try to leave her children more someday.

Actual assisted-living services are a different matter, IMO, which are more comparable to medical expenses.

[SeattleGirl]

11. My mom is in a facility primarily for health care reasons.

We are hoping she will be released in a couple of weeks to go back home.

[Lydia Leftcoast]

16. It's not assisted living if she's just getting meals

Assisted living is an intermediate stage between senior apartments and full nursing care.

My mother is in assisted living, and she gets not only a living space and two meals a day but also:

1. CNA's coming in to administer her meds and check her vital signs daily
2. Cleaning service
3. Laundry service
4. Physical therapy
5. Rides to the doctor
6. Help taking a bath
7. An alert bracelet for if she falls
8. An apartment designed to accommodate wheelchairs and people with either vision or hearing problems

As you can imagine, it's expensive, especially since my stepfather, who has Alzheimer's, is in full nursing care (in the same complex).

[pnwmom]

20. She pays a basic monthly cost to live in the assisted-living facility -- which

all residents pay, whether they get extra assisted-living services or not. She also pays for dinner in the dining room. Assisted-living residents pay for the extra services that they need, when they need them. This is an option that is always there if she needs it.

What I'm saying is that I don't think the taxpayers should have to be responsible for basic monthly costs that are not really medical costs but are comparable to the living costs you would have in an apartment building with a dining room, laundry, and maid service.

[cuke]

129. But what if the "basic costs" are higher at the ALF than they were at home?

What if the person can't afford the basic costs because they have spent all of their money on health care?

[lapislzi]

76. OK, we're not talking about leaving something for your kids, here

We're talking about the spouse who doesn't require care being out on the street because the house has to be sold to pay for the ill spouse's care. Should Dad die a pauper because he tried to do the right thing by Mom by having professionals care for her?

We're talking about the "assisted" part of assisted living--not a country club for seniors. You are fortunate to have a mother in law who needs no special care and can pay her way for the type of accommodation she desires. Sadly, she is in the minority. Many elders cannot function without a full-time helper--not a medical person, just someone to help them get through the tasks of the day.

And when you're talking about people with dementia or other disabilities, where does the "medical care" part end and the "daily living" begin? If the person has to be helped to the dining room or requires assistance eating...do you say, OK, we'll pay for the person to feed you but not the food? What's fair? Who judges when the elder is too impaired to stay in the home? Who judges whether a burden is too great to bear?

[pnwmom]

127. Some people are clearly talking about that, and that's where I disagree.

I agree with you that a spouse shouldn't have to be a pauper to pay for the other's care.

And some people have been talking about assisted-living facilities as if there is no distinction between basic living costs and assisted living costs. If an elderly person needs help, then they need assisted-living services. But I don't see the reason for any new government program to pay for BASIC living costs for all disabled seniors, without regard to income or assets. Assisted-living services are additional expenses and a different matter. And it is possible to separate out the costs. Facilities that offer different levels of care do this routinely.

I agree that patients with severe dementia have special needs and some plan needs to be developed for them. But that is different from supporting a universal long-term care plan that will cover assisted living or full time nursing for all seniors without regard to ability to pay.

[lapislzi]

138. I appreciate your efforts to explain, but we're going to have to agree to disagree

It's the George Bailey in me that would rather err on the side of compassion. Yes, I think that if you need the care, you should receive it, regardless of your ability to pay.

Once we take for-profit insurers and private equity funds out of the equation (since the hypothetical question concerned a universal single payer scenario), I think you will be pleasantly surprised at the funds available.

Cutting back on those nasty wars would also help.

Peace to you.

[pnwmom]

145. I've been against that evil war since the first murmurings post 9/11.

The costs have already driven us into a huge hole, I'm afraid -- one that could take us decades to climb out of even if we ended it tomorrow.

[lapislzi]

176. We have lost our way as a people

There is little compassion in our society today, although there is a great and continuous beating of the war drum. If you want to evaluate the health of a society, look at the way it treats its elders and its children. I am ashamed that we cannot even get a bill passed (SCHIP veto override) to help poor children get health coverage. Shameful. If there was an emoticon with a wagging finger, I would use it.

[hedgehog]

153. Another example - my aunt is moving into assisted care soon because

of macular degeneration - she's going blind. She can't drive anymore, I'm not sure how well she can handle cleaning and cooking. Now, she doesn't really need someone with medical training, but she does need assistance because of a medical problem. I think we (being we the people) can afford to assist people in this situation at least for the difference it costs between living on your own and living with assistance.

[frazzled]

10. Absolutely

It's an enormous issue, and will become more so as baby boomers age and start to need full-time skilled nursing care in some cases.

We were lucky to get my husband's mother into an excellent geriatric skilled nursing facility (a 'nursing home'). I really have no complaints about it (in fact, it's better than I ever thought it would be, and she is healthier now in some ways than when she went in, though the dementia continues to progress). The cost has been enormous, however. A few months ago, all her assets were depleted. Fortunately, it now switches over to Medicaid ... and she keeps the same room and nursing staff, as we were promised. Sadly, nothing she worked so hard for over the years will be passed down to her children. This is what happens if you live long enough (she's about to turn 95) but can't take care of yourself or your condition is too complex to be handled by family.

Aside from needing single-payer nursing home and home-health care provisions for the elderly, we need more trained geriatric specialists, nurses, and assistants. And we need to pay these workers more ... and give them benefits! A big shout out to the marvelous, dedicated health workers who dedicate themselves to the difficult work of caring for the elderly.

[NNguyenMD]

12. I guess the conflict with me is that assisted living isn't always a medical issue, but when it is...

not made availiable, very serious medical problems can ensue. I understand both sides of the issue, it is a devastating financial burden to the families involved, and on the other end there are many who do not feel that they should be paying for many would call supervised room and board. The medicines, the procedures, the surgeries and rehab I'm sure well all agree should be paid for under a universal healthcal plan, but when it comes to paying for the facilities and services to house someone who can't carry out the activities of daily living, it isn't so clear cut.

[pnwmom]

24. I agree -- the issue isn't clear cut at all.

Why should well-off retired people with substantial assets have the government paying for their long term housing in assisted living homes?

One of the other residents at my mother-in-law's place was down to his last $100,000 or so at age 92 -- after that money was gone, in another two or three years, he would finally have to sell his antique cars or his lakefront home. He ended up dying before he had to sell anything, and his nephew inherited the house and cars. But if he had had to sell his house, to pay for his current living costs, would that have been such a tragedy? He couldn't live in the house anymore.

When there are spouses involved, it's a different matter -- I wouldn't want to see one spouse put out of a house because another required care. But when you're down to one senior citizen and his assets, why shouldn't his assets be used to provide for his care? Why should his heirs get this benefit from the taxpayers?

[TahitiNut]

32. When the beneficiaries are required to be co-located with the caregivers ...

... those living quarters are, in large part, for the convenience and cost-effectiveness of the care. In the vast majority of cases, they're far less spacious and secure than what the patients give up. That's why I argue for home care and why I argue for subsidized residential facilities.

I mean the same 'argument' could be made for the bed in a hospital room. After all, the patient has to sleep in a bed anyway, right?

[pnwmom]

61. But subsidized for all? Without regard to assets or income?

How is the younger generation going to be able to pay for such greatly expanded social security benefits?

[TahitiNut]

66. Of course not. As noted in my first reply (#3) to which you responded, I support a copay ...

... for those with adequate assets. I do NOT believe a beneficiary should be impoverished. Insofar as preserving the beneficiary's core estate (home, car, cash up to about $75K, etc.), I think that's fair ... PARTICULARLY when an adult child or other heir surrenders much of their own independent life and moves in to provide care for the aging parent. Far too many people find themselves changing the course of their own lives to offer care in lieu of some 'institutional' setting and then find themselves homeless and bereft once the parent finally dies. Far too often we're seeing the end-of-life financial toll cascading down the generations.

[pnwmom]

70. I doubt that that many adult children leave their own independent lives

and move in to care for the aging parent, but in those circumstances they should be entitled to some recompense.

And I can see that a beneficiary should be left with some assets. But I don't see why all Social Security workers should have to pay more taxes so that a subset of heirs (who haven't been living with or taking care of their parents) can inherit paid-up houses from them. If someone sells their house toward the end of life to pay for a new form of housing, is this so unreasonable? Why should the taxpayers pay for them to keep a house they're not using and for care in an assisted-living facility, too?

[TahitiNut]

72. Let's TRY hard to not assume that such a facility is THE END OF THE LINE.

The tendency to regard assisted living as a pre-burial warehousing process seems to pervade the discussion. There are far too many individual exceptions to such an assumption to be overly one-sided in that regard. Not everyone's lives are so neatly categorized in terms of conventional relationships and prospects.

Too often I've seen the disposal of such assets as contributing to the DESPAIR of the beneficiary. I'm not at all interested in nickel-diming the "bottom 90%" ... while the "top 1%" rape the system no matter how many safeguards are enacted.

I'm reminded of the rabid lust to chase down the Katrina survivors who might've gotten a few hundred dollars too much ... and the abominable enrichment of the wealthy and the corporations went virtually ignored. It makes "penny-wise and pound-foolish" look like an unachievable ideal it's so bad.


FWIW ... I'm such a caregiver for my mother. "Only child" ... it's not just a demographic.

[pnwmom]

124. I know two such facilities well, one more assisted living,

and the other more oriented toward retirement living (with assisted living available for those who need it) , and for the vast majority of people there it is "the end of the line" --and they realize it when they come there. I know there are exceptions, though.

And the real financial burden is for long-term care lasting years -- not for short term, post-surgical care, for instance. When people talk about families being ruined by long term care, they're not usually talking about a month worth of care, but years or decades.

If you're most concerned with the bottom 90% -- and I know you are -- then why aren't you more concerned about all the young social security workers who would have to pay a lot more to fund what would be a vast expansion of benefits? Alreadly, with the baby boomers coming up, they say that eventually there will only be 2-3 workers paying in for every person taking benefits. How do we manage a brand new benefit of long term care on the backs of these workers?

P.S. Your mother is very lucky to have you. I hope you're taking care of yourself as well . . . it's scary to think you've given up everything for this. With a husband and children, my only alternative would be to have my mother come here, not the reverse.

[hedgehog]

155. The younger generation is paying for it now. The difference is

that the burden is not spread evenly. Person A has parents who die suddenly from a heart attack. Person A inherits the entire estate. Person B has a mother with Parkinson's and a father with Alzheimer's. Person B sees all the family assets consumes and then goes into debt paying the extra fees to keep Mom and Dad in the better facility because the government will only cover a portion of the fees.

[Devlzown]

13. That's why many people cede their property

to their children before they get sick. I think it has to be done at least two years before the previous owner gets sick. But I've known many who have held their parents' property and money so that the nursing homes wouldn't be able to take it all. It's some people's last fight before they die, and winning it gives them a certain amount of peace and comfort.

[pnwmom]

26. I wouldn't allow my mother to do that for my sake.

It seems unethical to turn a parent into a pauper -- qualifying him or her for Medicaid -- in order to inherit more someday. My mother's assets belong to her -- they're nothing I'm entitled to. What better use of her house, once she can't live there, than to pay for her care? (Places that accept Medicaid often aren't the ones you would choose if you had alternatives.)

[Devlzown]

33. This is done as last resort care.

I'm not talking about people shipping someone away to spend the last ten or even twenty years of their lives. These people take care of their parents at their homes as I will one day with my parents. A lot of the time they die at home, but sometimes they have to be taken to the hospital or nursing home to spend their last few weeks or months. These people are not abandoned and have access to all their assets.

[pnwmom]

36. Medicaid doesn't require people to give up their homes, does it?

But if a Medicaid recipient dies, the government could then go after the home in order to be paid back. Is that really so terrible? Should the government be in the business of subsidizing the bills of people whose estates could afford to eventually pay back the costs for their care? Should heirs get priority over general taxpayers?

[Devlzown]

38. These people are all general taxpayers.

These people who are dying have been paying taxes their entire lives -- why not get something back when they go? The heirs are taxpayers too, of course. It's all a stupid game we're forced to play in order to keep family property.

[pnwmom]

63. Why should one class of taxpayers, heirs of people who die with paid-up homes,

receive an extra benefit from the shrinking group of workers paying into Social Security?

I don't see it as family property. It's personal property. It's one form of housing that may have to be sold, eventually, to pay for another form of housing. It's not essentially different from selling one house to pay for another.

[cuke]

131. Because the costs of long term care exceed the value of the house

The real question is why people should be impoverished simply because they got sick. It's the same with ordinary health insurance. Why is it an issue with long-term care?

I'm not saying that anyone who wants it can just move into a NH. But when a homeowner with health insurance gets cancer, the insurance pays and they don't have to sell the house. Why is it any different just because, instead of cancer, they have dementia or some other illness that requires long term care?

[cuke]

171. Because people with dementia don't want to sell their house

Your argument assumes that people with dementia will make the right decisions

[cuke]

172. Because it's hard to sell a house in a bad market

[kineneb]

83. not a matter of "could" go after home, they already do

If a person/couple is on Medicaid in California, the state automatically gets the home when both spouses die; they keep reminding us of this by sending out fliers. I know that the state will get our house when I die, because Hubby qualified to get Medicaid, and I get CMSP.

He had no choice in going on Medicaid, since he had to go on dialysis. Fortunately, we have no children or close relatives in need, so inheritance is not an issue. I have willed my musical instruments to a state college, so there shouldn't be much problem there. But being almost dirt poor to get medical care means there will be little left after we die.

Ideally, what would happen is something like this:a special inheritance tax would cover the medical expenses of wealthier people. So if a person dies healthy, more money could be inherited; but if they needed extensive/expensive care, and can afford to pay, their estate would pay back the Gov. plan. Create a sliding scale, so that the tax would be fair.

[pnwmom]

125. I don't think all states are consistent about this. n/t

[cuke]

135. All states do this

Medicaid has a 5 year look back period. If the beneficiary had any assets during that 5 years period, they will bill the beneficiary. If they don't have the money, the state WILL seize the house

[question everything]

15. Have been wondering the same thing

specifically, whether this is addressed by any of the health insurance proposals by the candidates.

[NNguyenMD]

17. Clarification: I am specifically referring to a nursing home, not a Skilled Nursing Facility which

ABSOLUTELY SHOULD BE COVERED BY INSURANCE!

[Lasher]

18. Of course it should.

Here in WV if you have to pay as outlined upthread. You have to liquidate all assets, including your home, until you have nothing. Then you qualify for Medicaid, so they won't just throw you in a dumpster.

It is acutely unjust for estate taxes to be cut, and totally eliminated if some people get their way, while this scenario ensures that many middle class Americans will have nothing at all to pass on to their heirs. The Paris Hilton tax cuts help perpetuate dynasties, while end of life bankruptcies like these ensure the unwashed masses will always know their place.

[LibDemAlways]

21. My aunt suffered from Alzheimers and was in a nursing home

for several years before she passed away. My uncle paid $7500 a month for her care. Fortunately, he was in a financial position to do so. Most simply do not have the money.

Yes, long term care should be covered under Universal Health Care. This will become a huge issue as the baby boomers age.

[pnwmom]

29. The cost threatens to "break the bank" as baby boomers age.

As a baby boomer myself, I think we need to prepare ourselves in whatever ways we can, because I doubt that the government is going to be willing to add assisted living costs onto already burgeoning health care costs for our massive generation.

People who have any discretionary funds -- such as for vacations or newer cars -- should really think about putting the money instead into good long term care policies.

[LibDemAlways]

44. Yesterday on one of the morning shows there was

a segment on baby boomer retirement savings. According to the poll they were quoting, almost a quarter of the respondents had saved exactly nothing for retirement. That's a scary statistic. It means we're looking at a future where a sizable segment of the senior population is going to be trying to get along on Social Security, and today that is nowhere near enough.

Our culture has become so focused on "buy the Mcmansion, drive the nice new car, own the big screen tv, take that trip to Vegas" people have no idea how to save, and many are so strapped from raising their kids and paying for braces, college, and big weddings, they have nothing left. There is no thought to the future, and certainly not a future of spending years in an assisted living situation or nursing home.

My aunt and uncle never had children - which was one of the keys to their wealth. They grew up during the depression, worked hard all their lives, lived frugally, put their money away - and it was there when they needed it. People today are an entirely different breed.

[pnwmom]

64. I'm afraid you're right.

To be able to live even in a modest, but secure, way all the way through to retirement, we need to live frugally now -- much more frugally than a lot of people realize.

I think it's easier for people who have had the examples of older relatives, as you have. My husband and I benefited from that, too.

[cuke]

133. I'm one of those people with no savings

I used to have savings, but then my mom got Alzheimer's so I had to quit my job to take care of her.

If long-term care were covered, I wouldnt have to ruin my career and my life.

[lapislzi]

82. Ever hear of the "sandwich generation?"

It's people in middle adulthood (prime earning years) who are faced with the difficult choices of caring for aging parents while trying to provide a decent life and opportunities for their children.

Which do you choose? A home health aide for Mom or tuition payments for the kid?

It's not as frivolous as new cars and vacations--at least not for most. And I find your "should" insulting. People "should" do a lot of things. Most don't, and won't. And I would sooner die a bag lady in Central Park than give one more dime to another insurance company for another "policy."

[hedgehog]

158. Not to mention trying to save for retirement while still paying off a mortgage!

I was paying 12.5% at one point on a fairly modest house. I'm still paying it off after living here 20 years.

[lapislzi]

174. You'll be paid up just in time to hand it over to the for-profit elder care facility

What a nice gift for them.

:sarcasm:

[lapislzi]

175. You'll be paid up just in time to hand it over to the for-profit elder care facility

What a nice gift for them.

:sarcasm:

[kineneb]

169. prepare ourselves? how? cyanide pills?

We have already cashed out all of our assets. When Hubby dies, I will get the car and the house and nothing else, because there isn't anything! Because of other health issues, I won't be able to work full-time then. So I am looking at living on no more than $600/month to continue to qualify for low-income healthcare. I won't be eligible for Medicare or Soc. Sec. for some time.

As to putting money away for such things, forget it. Whatever gets put away will not be enough, due to inflation; one still winds up being broke. May as well have those life experiences now, because they can't be taken away. I would not give up the last trip Hubby and I were able to take together for anything. He is now very ill and tied to a dialysis machine three days per week. Live now. Tomorrow you will be pennyless anyway (unless the system gets changed...don't hold your breath).

[cuke]

178. I was preparing myself. Then my mom got Alzheimer's

It's cost me over $200,000 so far

So much for retirement savings

[nadinbrzezinski]

22. Yes, the cost is equivalent to buying a house

so definitely yes

[Spinzonner]

23. Unfortunately, we are at a state of medical technology

where we are able to keep people alive much better than we are able to keep them healthy.

Hopefully that will change for the better as the knowledge and technology improves. If so, maybe the dire predictions for the future will not be as drastic as anticipated.

In the meantime, we have an economic problem bridging that gap. One possible solutions to the cost is to make the care more involving of family and other volunteers. Easy to say, but how ?

[NNguyenMD]

25. I was just thinking that the thousands of dollars a month it costs to put someone in a nursing home

you can take half the price, and it'll be more than enough to train and pay for the cost of a willing family member who will care for that person full time. B/c if it costs 70K-100K a year to care for someone at a facility, you can do it for half the price if you've got a willing family member or friend who wants to do that job full time. I would much prefer just giving them the money than going through the mess of a nursing home.

[pnwmom]

27. I know someone who was able to do that for her mother, because her mother

qualified for Medicaid. My friend took the training required by the state to be paid as a home health aide to take care of her mother. (This actually saved the state quite a bit compared to nursing home costs.) After her mother died, she took her new skills to another family that needed an in-home care giver, and she's still working there, five years later.

[cuke]

136. Only a few states do that

It's pilot programs so only a few benefit. But this is the answer.

[endarkenment]

47. Average stay in nursing homes is under two years.

People go there to die, and they generally do so rather quickly.

[cuke]

179. Very misleading

Most people in NH's are there for weeks or months. A smaller portion are there for many years.

Averages can be misleading. Put Bill Gates (est worth: $60billion) in a room with 59 homeless people, they will all, on average, be worth $1 billion each, but 59 of them are still going to be sleeping on the streets.

[endarkenment]

197. Oh I agree.

That is the point: yes nursing home care is very expensive, but generally it is so for a matter of weeks or months, not years. The costs should simply be covered by medicare, which should be extended to everyone and paid for as it is today through the FISA tax. Yes all of us working people would pay higher taxes, as would all employers, but we as a society would benefit from the security of knowing that our aged parents, and in turn ourselves when we grow old, will be cared for.

[undergroundpanther]

30. yes

[kath]

34. How do the Yurpeens handle this issue? Anyone know?

[eridani]

35. Absolutely

With what we are spending now, we could have platinum-plated health care. All we need to do is to switch the payments we are now stuck with for denying people care, and spend the money on actual care.

[pnwmom]

37. Oh really? We would essentially be creating a giant new welfare class,

with no income ceiling, including many people whose estates -- either now or after their death -- could well afford to pay for at least their basic living costs, and maybe even all their costs. (Assisted-living facilities include both a place to live AND extra health benefits.)

Is everyone here really thinking this through?

Do people here really think that 20-somethings making $30,000 a year should pay more taxes so that 60-somethings with half a million dollar homes can have free long-term assisted living care courtesy of the government?

[sandnsea]

39. You will never get it

60% of the country is fucking BROKE and always will be broke. These are the people everybody is concerned about, not your goddamn 1% with their million dollar homes. If the rest of us can have necessary care and peace of mind, then I just don't care if the 1% cheat the government out of a house. If you want to work your entire life to hand your home over to the 1%, I guess that's your business too. Some of us know that the money from the poor person's house isn't going for an inheritance, it's going to pay for all the stuff Medicaid doesn't cover. Is grandma with Alzheimer's going to lay in the nursing home naked because there's no money for clothes? You just don't get it.

[pnwmom]

55. You don't get it. During the lifetime of the baby boomers,

there will be only 2-3 people paying into social security for every person collecting it. How are those young people going to be able to afford new hugely expanded Medicare benefits going to all baby boomers regardless of assets?

[sandnsea]

103. We already paid our retirement

The 1% took it. Bush gave it to them. Now you want to give what people managed to scrape together, in spite of higher taxes, to the 1% too. Cut defense. Make the wealthy give back the FICA that they stole. I'm not giving up another damn dime until that happens, and no other working class American ought to either.

[lapislzi]

91. Right on! And if you think for one minute that the 1%

would be caught dead in a facility with me and mine, you're nuts (not you, sandnsea...you definitely get it!)

When the time came for my dad to go to assisted living, it was tough going. Although he had some means, he was a former Marine and teamster who wanted NOTHING to to with the ritzy country club places that seem to be popping up all over the NY area (that charge upwards of $8k a month). He wanted decent food, his smokes, and a card game every night. Dress for dinner? Hell, you couldn't blast him out of his "comfy jacket" with dynamite.

Chalk and cheese. The rich will always have means and hold themselves apart.

[endarkenment]

46. Why are you even here?

[Zorro]

48. I'm considering getting long-term care insurance for my wife and myself

Even though it's expensive ($3-$4k/year for both of us), the alternative is worse.

It's something everyone should be considering once they pass 55; expecting the government to ride to the rescue and create a program to provide this type of benefit is wishful thinking.

People need to be responsible and make their own arrangements ahead of time; it's a matter of budgeting those costs into your monthly expenditures.

[supernova]

52. It's more than that

It's great that you can afford LTC ins. I wish everyone could.

This is yet another example of why we really do need universal health care in this country. The idea that everyone is their own independent financial island is a myth, and a damaging one at that.

[pnwmom]

57. But universal health care wouldn't mean universal living costs for

every person of social security age who needs some degree of special assistance. Assisted-living places charge a basic fee for living costs. Added to that are fees for additional services. While the government conceivably could begin to pay for additional medically related services, do you really expect there to be a major expansion of benefits to pay for basic living costs of all disabled seniors, no matter what the income?

[supernova]

75. Did I say that?

I said, we do need to provide a way for people to have this care when they need it.

If we don't, it's just another way of blaming people for being sick.

[cuke]

142. You just don't get it.

"Assisted-living places charge a basic fee for living costs. "

Which are much higher than what it costs to live on one's own. My mom paid $200/mo maintencance on her co-op. Add in utilities, phone, cable, food, etc and you still come up with a monthly expense far lower than what an ALF charges.

"Added to that are fees for additional services."

And those fees are higher than what it costs to get those services independently. The ALS and NH's say it's due to "administrative costs", otherwise known as "profits"


"While the government conceivably could begin to pay for additional medically related services, do you really expect there to be a major expansion of benefits to pay for basic living costs of all disabled seniors, no matter what the income?"

Health insurance pays for medical care regardless of the person's income. Why should it be any difference simply because the disease requires long term care?

[frazzled]

53. Do not expect that to cover anywhere near the full cost of care

if either you or your wife should need to be in a full-time skilled nursing care situation. My parents have had long-term care insurance for many years now, and they admit it will pay only a portion of the costs. They are doing everything they can to avoid having to end up in a nursing home.

And it could be way longer than the 2 years someone above suggests. My sister-in-law's father suffered a severe stroke in his 60s that eventually necessitated moving him to a nursing home. He lived another ten years there. My mother-in-law didn't need this kind of care until she was over 92 and became both physically and mentally unable to live in assisted living. The cost has been $7,000 per month.

[pnwmom]

58. The plans vary, and so do the costs, terms, and benefits,

with the costs also varying depending on how young you are when you take out the policy.

This is definitely a case of buyer beware.

[cuke]

144. It's not just just

Most LTC policies have a lifetime limit. That limit does not cover the costs of LTC for someone who needs LTC for a long time

[pnwmom]

56. We're doing that. Some of the people who think they can't afford it

are spending more than that on cigarettes each year, or on other things that aren't really necessities. We drive ten year old cars, go camping locally for our vacations, etc,. and put the money we save into long term insurance and retirement. I don't want our children to ever have to worry about us, the way we have for some older relatives.

[hedgehog]

159. Correct me if I'm wrong, but if you stop paying for that policy in

10 years because the premiums go up , don't you lose your coverage and everry penny you've put in?

[Romulox]

54. Thank you for your posts. For too many, this is an issue about INHERITANCE, not care for seniors...

Given the demographics, it may well be that in order to care for all seniors, middle class boomers are going to have to give up the idea of "the government" (read: younger workers) paying all their parents' expenses in order to preserve probate estates. Meanwhile, we younger workers are simply praying that the basic Medicare/SS system will still exist when it comes our time to retire. Intergenerational justice and sustainability must be a central portion of any solution.

[lastliberalintexas]

The better idea would be that we are forced to give up the idea

of for profit companies running these facilities, wouldn't you think? Cut out the profit margin, and we wouldn't have companies charging $8-10K per month for substandard care.

And for the record, I'm a "younger worker" who fully expects the system to still be there, assuming that the US exists by then anyway. Intergenerational bickering only helps those trying to divert attention from the real problems.

[Romulox]

101. Tell it to Hillary. According to her, for profit health care providers "are people too"

And they definitely have a seat at the table. And I'm sorry, asking for intergenerational sustainability and fairness is not bickering.

[lapislzi]

77. For me, it's a simple formula

Did you work? Did you pay your taxes? Did you contribute to society?

Then you deserve to spend the final years before your death in some kind of dignity and comfort. Not a country club. A comfortable place where you're safe and have enough to eat and a doctor if you need one. Is that too much to ask? Apparently for some it is.

And yes, I DO think 20-somethings should pay more taxes. Then THEY can have care when they're old. That's how it's always worked. It's called looking out for your neighbors and I thought that's what we stood for. I think everyone should pay more taxes. There. I said it. Flame me.

[lastliberalintexas]

85. Thanks are due to you and sandnsea

Why someone upthread is so fucking focused on the few who would potentially be "cheating the system" by being able to pass their home and some money to their kids is beyond me. The focus should be on the fact that this scenario is often one that essentially bankrupts the elderly and severely impacts their families, not just related to inheritance. The (emotional and financial) strain and stress of caregivers can tear families apart, so it isn't just a matter of greedy people worrying about an inheritance. Why don't we instead worry about the greed of the people running these facilities, bilking the treasury and families for thousands of dollars each month for what is often substandard care? Why focus on the have a littles when it's Corporate America that's yet again the real problem? (because if anyone actually thinks the truly wealthy are going to the same facilities as you and I, you better think again)


And boo fucking hoo. If someone wants to try to pass on the relatively paltry $100K amassed during a lifetime of hard work rather than ensuring that the for profit motherfuckers running nursing homes into the ground get even more money, more power to them. The idea that the taxpayers are being cheated is ridiculous. Instead, someone is actually arguing that even more money from the elderly should be paid into the profits of the facility that often ends up killing (directly or indirectly) your loved one.



Sorry for the language. Healthcare and elder care issues get me a tad riled.



oh and on edit- We wouldn't actually have to pay more in taxes, though we might be forced to choose between aring for our people and waging illegal wars of choice. Easy decision, don't you think? :)

[lapislzi]

93. You go, LLIT!

I went through this very thing with 2 elder relatives...so I feel what you're feeling.

You are right about the tax issue and the profit issue. I was so irritated with the other poster that I forgot to mention those points in my posts.

:hug:

[lastliberalintexas]

100. Hey lappi

:)

I saw your post about being a caregiver, so I can try to empathize with what you've gone through. I've never been in that situation myself (so far anyway), but I've seen one family member and one friend deal with caregiver issues. It just isn't an easy life.


And as to the other issues, my Socialist tendencies go on display when we talk about healthcare. Like you, I think everyone in our society should be treated with compassion and respect, regardless of ability to pay. If the multi-billionaire chooses to enter the state run nursing home rather than Exclusive Old Jerks R Us, then yeah, I think we should pay for that too. For everyone, *regardless of ability to pay*.

[lapislzi]

112. Agree 100%

Tho' it would give me a giggle to see snooty Mrs. JABIII (friend's waspy mom) rubbing elbows with the Eddies (my dad) of the world. Who knows...we can all learn from each other, right?

I'd rather risk a few mistakes and cheaters while erring on the side of compassion.

Peace to you!

[Romulox]

95. You forgot demographic sustainability in your simple formula...

Unless such programs are sustainable, you can't argue that 20 something should pay more to you and your generation while simultaneously being "on his own" when it comes his time to retire.

Standards of living have decreased considerably in this country in the last 30 years. The baby boomers will have to share in the lowered expectations of an America that is simultaneously becoming older and poorer.

[lastliberalintexas]

98. Oh bullshit

Lowered expectations my arse. Quite bending over for Corporate America, implement a real, progressive income tax, take the profit motive away from healthcare, implement universal healthcare and- voila! You almost have a utopia. Well, at the very least you have a country in which people can be cared for without bankrupting their families.

[Romulox]

99. And which of the "free trade"/ laissez faire Democrats are proposing ANY of those things?

All of that would be wonderful, but the powers that be won't allow it. All I know is that both Medicare/Medicaid and Social Security are demographically unsustainable as they stand now right now.

That means that these programs will not exist as we know them for a worker who is currently under 40. That's not something you can just blow off. It's a hard, cold truth.

[lastliberalintexas]

104. That wasn't what was asked by the OP

The OP asked if a *single payer/universal healthcare system* should cover these expenses. Perhaps that's the problem in this thread, many people are only thinking in terms of Medicare/Medicaid, when that wasn't what the OP asked.

[Romulox]

106. You make an excellent point. Truly universal care must be the goal.

I suspect we basically agree on the principle point: I support universal health care 100%. I do not support adding more benefits for seniors while continuing to exclude almost 50 million of our poorest working people and children from any care at all.

[lastliberalintexas]

113. Yes, we do agree on universal healthcare

I'm glad we cleared that up. :)

[sandnsea]

107. Cut the defense budget in half

Take our FICA revenues back by raising taxes on the wealthy, voila, we're sustainable. They stole our FICA money. Baby boomers have been paying excess for 20 years to prepare for our retirement. They gave it to the wealthy. We just need to get it back from those who took it.

[Romulox]

111. I'm with you 100%. Unfortunately, you and I both know that this is politically unfeasible.

You can tell me what "should" be done all day long. But what *is* being done is that we are just borrowing money from our grandchildren's retirement account without cutting any spending at all.

People who are young today will need to retire one day too. What are they supposed to do when the programs aren't there for them? :shrug:

[sandnsea]

115. They told us the same thing

They told my Dad the same thing. The programs will be there as soon as we quit letting the politicians lie about where the social security went. The first big lie was Clinton's budget surplus. Al Gore tried to tell the truth, and we didn't help him. If it's important to us, then we have to stop using right wing language and start telling the truth.

[Romulox]

116. Yes, it's *possible* Medicare/SS will still be around, but **not with the current tax structure**

It's also *possible* we could return to the moon, but I'm not betting my retirement on the off-chance that we get around to doing so anytime soon.

My point being, saying "things always work out," is not good enough. Medicare and Social Security can be restructured, but its going to mean means testing and uncapping FICA assessments. There is no way we can cut taxes, raise benefits, and endeavor to preserve probate estates for the baby boomers at the same time.

That means no Medicare long term care benefit. Thank god Medicaid exists!

[sandnsea]

121. It is not a welfare program

The second you turn it into a welfare program, you lose it. It is insurance against loss of income. INSURANCE. Not a retirement plan. Old Age, Disability and Survivors Benefits. Young people often forget the Disability and Survivors part. You are not just giving up some old hippie's retirement - you're screwing with your own standard of living should you become disabled, or your children's if you die.

And why in the world would you differentiate between Medicaid and Medicare? All the money comes out of the same pocketbooks, OURS.

[Romulox]

128. Of course it's a welfare program, or else it would pay for itself...

If Medicare/SS weren't welfare programs, they would be self-sustaining. They're not.

And why in the world would you differentiate between Medicaid and Medicare?

Because Medicaid already has a long-term care benefit. Medicare does not. Understanding this is key to understanding the entire issue.

[sandnsea]

134. FICA funds the federal budget

not the other way around. You're flat out being lied to. If they were using that FICA to pay down the debt, then the money would be there to pay us back. The only reason it isn't is because they gave our excess payments away, are piling on debt, in order to kill the main social safety net in the country. SS is proof socialist programs can be beneficial and the right hates that.

Medicaid is for low income people. We pay for it. Why would you force people into poverty before you agree to provide a long-term care benefit? Whether it's Medicare or Medicaid, WE PAY FOR BOTH.

Not believing the Reagan lies is the key to understanding the entire issue.

By the way, by 2040, most of us boomers are going to be DEAD. So why are you letting them lie to you about the sustainability of SS when we won't even be alive for the so-called unsustainable formula to apply to.

[Romulox]

165. I'm well aware that FICA is being diverted to the general fund

However, the funds are still spent and gone, and must be repaid by current workers.

By the way, by 2040, most of us boomers are going to be DEAD. So why are you letting them lie to you about the sustainability of SS when we won't even be alive for the so-called unsustainable formula to apply to.

:wow:

So you'll be dead, screw me and everybody else who will remain? Just stunning. :wow:

[sandnsea]

105. It hasn't decreased for the wealthy - WAKE UP

You are advocating economic injustice, just shrugging your shoulders and not fighting for working people to get their fair share.

[Romulox]

110. I'm not advocating economic injustice--merely pointing it out.

By and large, no one is fighting this problem head on--the solution can't be for younger workers to pay whatever outrageous ransoms for-profit health care providers demand, only to be left out on their own when it comes their turn to retire.

[cuke]

147. You're pointing out things that aren't true

SS is not subsidized. It runs a surplus that helps fund our budget deficit.

And that stuff about "outrageous ransoms" and "being left on their own" is just empty rhetoric based on nothing but speculation and right-wing nonsense

The fact is, we are paying for it right now. It's being paid by the children of these seniors who have to quit their jobs to care for their parent. It's being paid by every child that has to help their parent pay for the care that the govt does not provide.

[lapislzi]

118. I think it can be done quite simply

1. By renouncing costly wars of choice
2. By removing the "for profit" component of the equation

It is the for-profit insurance companies and private-equity owners of the facilities that are CLEANING UP on our elderly. You could bring the per-head cost down dramatically by just eliminating that variable.

What sort of "decreased standard" should I be willing to settle for? Already the non-medical staff in many elder facilities is of the lowest standard--part-time, minimum wage employees with no benefits. I have witnessed this firsthand. Although usually very caring and compassionate, these people (mostly young women) haven't the first idea about how to care for elderly people. Health-related staff have been cut to the barest minimum so that one nurse aide might be caring for an entire floor of people with various disabilities.

What should I be willing to settle for after working for 60 years and sacrificing for my children? A bed in a dormitory with 19 other wheezing geezers?

What should I be prepared to settle for in this brave new world? Should I resign myself to being sedated with heavy psychotropics 24 hours a day because that makes me easier to "manage?" (Yes, they do it.) To have my "privileges" taken away because I'm a behavior "problem?"

I need to know so I can get ready. I need to know what reduced standard I'm looking at so I can get myself a nice shiny shotgun shell and carve my initials into it.

In a word: bullshit.

[Romulox]

120. OK, I agree, but what's stopping us from making these changes?

Listen, I don't like that money/power is the name of the game, but it clearly is.

I will be right behind you supporting not-for-profit universal care, but I'm not optimistic at this point. As far as what reduced standard of living you "should" expect, I hat the word "should". Should according to whom?

All I know is that the current system is unsustainable. I am more than willing to help try to fix it, but I don't think I'm the primary impediment to reform. More likely the healthcare/pharma industry (who are, incidentally, key financiers of HRC's campaign,) pull the strings here.

Adding vast new benefits to a program already collapsing under its own weight is a non-starter without providing a vast new source of financing.

[lapislzi]

123. Too few people , too little anger

This whole thread is a theoretical discussion. I know as well as you do that we're far from critical mass on these issues. Bread and circuses do their job very well. But that doesn't stop me from becoming angry about it, about a bait-and-switch that's been going on for decades. As long as you still have folks taking the bait, you can get away with the switch.

Oh, they'll even throw us a bone once in awhile to preserve the illusion of choice. But ever since corporations became "persons" (or, more accurately, "super persons"), they've called the shots and will continue to do so. Our job, apparently, is to work very hard, support the banking, credit card, and insurance sectors, eat bad food, get sick, buy their medicines, and die.

In some ways, I feel sorrier for the people who actually buy the bullshit, because they're the ones in for the rudest shock. I was being sarcastic in my post above, but I am fully aware that the fate I described is probably what I can expect for myself. I watched my father, once a Marine, wither and die in front of a big-screen TV, doped to the nines and putrefying in his own piss because the $5000 a month facility had just made a new round of staff cuts on the advice of a private equity fund management company.

Hence the shotgun shells. I will not give anyone the satisfaction of wringing every last dime or every shred of dignity from my person.

Sorry, this is rambling somewhat...but this issue does rouse my ire.

[pnwmom]

132. But there used to be a lot more younger workers for every recipient

than there are now. That's a huge problem, and it's getting worse, because the baby boom generation is so large and everyone's living longer.

[sandnsea]

137. In 34 years, we'll be dead

By 2041, there won't be very many boomers left. You need to be looking at whether YOUR generation is sustainable by the next generation. We paid for our own retirement already and it is funded until 2041.

[pnwmom]

141. It WAS funded till 2041 -- but I understand that Bush has raided the

system and we're not funded again. Also, this discussion is about what would be a new benefit, and that wouldn't have been included in any previous calculations.

I'm a baby boomer, by the way. Right in the middle of the boom.

[sandnsea]

146. Get the money back from the rich

Quit repeating the bullshit lies about it being unsustainable bla bla bla. We paid for our retirement. Why in the hell are you letting the rich steal it from you??? And then you want to turn around and give them all that you've worked and saved for on top of it. You are thinking as if you're one of THEM, and you aren't and you never will be. You're as bad off as a minimum wage worker, one medical emergency away from that, and you ALWAYS will be. The only way to protect what you have is real universal health care that covers EVERYTHING.

[pnwmom]

152. Thanks to the war, our whole economy is teetering on the brink,

the dollar is dropping like a stone, and gold is over 750. Whoever the next President is going to be, I don't know how he or she will get us out of this financial hole that has been dug -- it could take decades. Even if the war ended tomorrow, which it won't.

It would be nice if I were proven wrong, but I don't see any major expansion of benefits in the economy we have now. So I'm buying long term care insurance, hoping it's enough, and not counting on any government benefits being there.

[sandnsea]

160. You can't control life

I know you're desperate to believe you can. Religion, insurance, college, investment, responsibility - you hang on to it because the alternative is too frightening to even consider. You always feel one step ahead of poverty and it terrifies you, the only way to escape it is to be morally good so karma doesn't get you, and be economically responsible to prevent any tragedy, seen or unforeseen. It's like being a mouse in a wheel, run run run. One of these days you'll realize the wheel is hooked up to a vacuum and all that running is doing is producing massive wealth and comfort for less than 1% of the people on the planet. That's it. Your sense of security is all a mirage.

We can't get away from the reality that the 1% will always control the wealth and resources of the planet. The best we can do is demand we get our fair share, which they won't even notice is gone.

It's not that they don't have the money. They don't care that it's spent, look at the defense contracts and the money they pay in bribes and to lobbyists. They just don't want the masses to have the power that economic freedom gives, they saw the result of economic empowerment in the 60's and it scared the shit out of them. They've been taking away our economic power ever since. The only way to get any of it back is to demand it back. You'll never get the peace of mind you're seeking any other way.

[pnwmom]

166. You're right, I am trying to be personally responsible

and conscious of the next generations and their needs. And I don't see that "demanding" is going to get us far in light of our devastated economy.

Mea culpa.

[sandnsea]

170. You're trying to bargain your way out of catastrophe

Has nothing to do with any concern for any next generation. You might hit the jackpot and catastrophe may not fall on you, but it won't be due to your "responsibility", it'll be due to luck. Luck to be born with brains, luck of parents, luck of healthy kids, luck of not choosing a shrinking career, all kinds of luck. Sure, you can do things to increase your odds, but you can't beat them altogether. Nobody can.

But you keep convincing yourself otherwise, and the wealthy keep playing on your over-developed sense of personal responsibility, to suck every last dime out of you.

You could work for what you have, and have peace of mind too.

I don't know why you're willing to sell your peace of mind to the highest bidder, for some silly phony notion that you're taking care of yourself, when you don't have anything the rich don't want you to have anyway.

We're 5% of the population. You honestly think we can maintain our standard of living in this global economy? There's enough labor around the world to drive our wages down for decades. Your turns coming.

[pnwmom]

180. And your solution? To "demand" whatever you want?

Good luck with that.

[cuke]

182. No, the solution is a single payer, universal health care system

that covers long term care

[Romulox]

167. In the long run, we'll ALL be dead

So that's just as good reason to raid your retirement as mine (which is to say it's a shitty reason in both instances.)

Why should I care about your medical care if you don't give a damn about mine? :wtf:

[lapislzi]

140. Yeah, and we're a lot fatter and sicker

all the better to buy their drugs with. Without funds to purchase the care and the medicine, we'll all be dead a lot sooner.

[hedgehog]

161. There used to be a lot more farmers for every person, too!

Increased productivity means we don't need as meany people working to support the economy.

[pnwmom]

168. That analogy doesn't work for me.

We have a lot fewer workers to support more and more recipients, who are living longer lives than ever. Productivity doesn't seem to be the issue here.

[hedgehog]

177. You're thinking in terms of money. Money is only a representation of

goods and services. Here's the question: how many people does it take to feed, house and clothe the nation? You can have all the money in the world, but if there as no food, you're out of luck. I maintain that the problem here is to distribute the goods and services more equitably.

[pnwmom]

181. But when a greater and greater part of the population will be

elderly and disabled, it will be a huge challenge to maintain the services we have already -- much less to considerably expand them.

On a social level, I'll support the idea of providing long term care to everyone who needs it. If a Democratic administration can figure out how to do this, great. But on a personal level, I'm expecting to have to provide for myself. I'm not going to count on major changes occurring in time to benefit my generation, and I don't want my adult children to have to choose between caring for me and caring for their own kids.

[cuke]

183. Wrong

It is more expensive NOT to cover them. Billions of dollars are wasted because they are not covered.

And those people are going to age with or without health care. Someone is going to pay. Why should people be unable to get affordable insuarance for long term health care through the govt?

It doesn't cost money to insure people. It costs money to treat people, but those people will need treatment with or without insurance. People can pay a small amount out of their taxes, or they can be hit with bills they can't possibly pay in the future. Either way, the treatment will cost the same

[TahitiNut]

191. Here's the ratio of workers to OASDI beneficiaries for the last 30 years ...

The "Doom and Gloom" forecasts are based in part on the decimation of the labor force under the two Bush administrations. We have ten million fewer people in the labor force today than just average growth should have provided since 2000, where that 'average' is based on the last 50 years.

The eligibility age for full benefits has been raised from 65 to 67. If "mandatory retirement" were outlawed and the age notched up only one more year, there'd be no problem. Direct patient care can't be off-shored.

[eridani]

193. There would be co-pays, of course. n/t

[Ayesha]

40. No

However, it should cover in home care in the person's home or a family member's home. I'm so sick of seeing elderly and disabled people warehoused in nursing homes and it needs to stop. Such places should be shut down. We need to take responsibility for our loved ones as humans have throughout history.

My grandfather lived with my family until he was 96. My mother honored and respected him for all he had done for her, and so she took responsibility for his well-being. When he became ill, she arranged for in-home care, but Medicaid wouldn't pay for enough hours to meet his needs. They would, however, pay for a nursing home, so my mom was forced to place him in one. She found a very nice place and drove 30 miles twice a week to visit him, but it still broke her heart. And it shouldn't have had to happen.

[pnwmom]

67. No, that shouldn't have to happen. What a waste. n/t

[cuke]

148. That's what you're advocating

even if it's unintentional

[pnwmom]

154. No, I'm not.

I'm saying that universal assisted living or nursing home care without regard to income or assets isn't a benefit that the system, or the younger generation of workers, can afford.

[cuke]

163. I know what you said

and you're wrong on both counts. Single payer, universal health care is an unquestioned benefit (on DU) and it has no income test. SP/UHC pays for care regardless of the insured's income or wealth. Why should it be different simply because illness happens to be one the requires long term care? It's an insurance program, not a welfare program

As far as the expense goes, it cheaper to pay family members to care for their loved one than to have them put in a facility. Not only is that cheaper, but you don't have two lives (the patient and the caretaker) ruined.

It's cheaper to cover LTC than it does to not cover LTC

And if the younger generation has to pay for LTC out of their pockets, then NOT having universal LTC is something younger workers can not afford.

[lastliberalintexas]

89. Except that some elderly can turn abusive in their old age

Possibly from some form of dementia, I guess. My great grandfather turned into an abusive asshole to my grandmother and her sister who cared for him in their homes over the years. Since that was so long ago, I don't know if he had some undiagnosed issues which precipitated the abusiveness, but from all accounts he changed drastically over the years. Also, caregiver stress can be tremendous, and not all families are equipped to deal with it.


I understand and agree about the substandard care received in most nursing homes. I just don't think there is a one size fits all solution.

[Feron]

94. Ideally a person would receive in home care,

however that isn't always feasible. My grandmother has dementia and is a danger to herself and others outside a controlled environment. She had caches of weapons (broken off broomsticks, hedge clippers, knives, boards, etc.) hidden throughout her condo because the paranoia from the disease led her to believe that imaginary people were stealing from her.

And no one would visit her because they were afraid she wouldn't remember them and attack. My grandmother never did anything violent thank god, but it was only a matter of time if we had left her alone.

As an aside, all of the "stolen" items were discovered when we packed up her condo. She just doesn't remember where she puts an item, thinks it has been stolen, and then hides the replacements. Wash, rinse, repeat.

Of course that doesn't even cover the roaming and other issues that arise from dealing with this awful disease. If someone is able to care for an elderly family member, then good on them. However sometimes being responsible means putting a person in a facility that can provide proper care that you cannot give.

[davekriss]

41. Yes

And hospice when necessary too.

[endarkenment]

45. yes on nursing homes, partially on assisted living.

The 'assited' portion of assisted living is medical care that should of course be covered by universal health care.

Nursing home costs are around 70,000/yr above the medical care provided through medicare coverage. Costs vary depending on location and quality of the home. UHC should of course also cover in-home care for those who take their aged parents into their houses rather than institutionalize them.

Wouldn't it be nice if we really had a compassionate caring society?

Wouldn't it be nice to know that our tax dollars were being put to good use rather than crimes against humanity?

I can dream, can't I?

[supernova]

50. Absolutely YES! Long term care and disability care

is a primary bankrupter of families caring for either a disabled person or an elderly person needing end of life care.

The present systems of for an elderly person to GIVE AWAY or USE UP all their assets: house, money, valuables they've earned all their lives in hopes of passing on a legacy to their children and grandchildren, so that they can get on Medicare to pay for nursing homes and PT, in home care (though I don't think medicare does in home nursing) and whatever else is needed.

It's appalling and should be stopped.

[pnwmom]

68. So you think all Social Security workers should pay higher taxes

so that some people can inherit paid-up houses from their parents?

[supernova]

73. The country club set will always

have what they need. I'm not the least bit worried about them nor their precious trust funds.

What I am concerned about are folks who work hard all their lives, manage to build up some small amount of financial stability after 30, 40, 50 years, to see that the kids can go to college, or buy a house, or whatever they need to do to get to the next rung on the ladder.... only to have it all dissipate because they had a stroke, or a hip replacement that didn't heal properly, or a heart attack, and can no longer care for themselves and must spend ALL THEIR RESOURCES on health care.

Your zero sum "arguments" are pointless.

[pnwmom]

130. It is not a zero sum argument, it is an argument about generational equity.

The expenses of care of the baby boomer generation are already going to be enormous. I don't see how the younger workers can bear an even greater expense.

Selling a home in order to pay for housing for the rest of your life doesn't seem that problematical to me. If my mother-in-law needs to sell her house and spend all the proceeds on herself, so be it. She won't need it after she dies. We would rather see her well taken care of now than inherit the house later.

[supernova]

139. Oh, so this is really about

your being resentful at taking care of your mother in law.

I see.

[pnwmom]

143. I don't understand where you're getting that at all.

I'm not having to take special care of her and I enjoy having her nearby. But I think she should be able to spend her assets on herself and not worry about how much she'll leave to my husband.

[supernova]

150. That's the whole point of LTC

"not worry about how much she'll leave to my husband."

Whether she does or doesn't will be her choice, hell spend it on cruises for the next x years if she or any other older person wants to. Or leave it to the kids.

But the problem is, many people don't get that choice. The way the system works now, they MUST dissipate their resources. And, as others have noted in this thread, the caregiving takes a toll on caregivers who don't get any relief, often for many years.

I really don't want to know what kind of slimy morals you have to justify that kind of toll on your fellow humans and citizens. Everyone will be old eventually. Even you. And you will need care too. Perhaps even indigent care.

[pnwmom]

156. You twist everything I say and then

you talk about "slimy morals." What a prize you are.

[supernova]

173. Now, we're getting somewhere

:-)

And I am indeed a prize, as is anyone who values themselves and their fellow human beings.

My point is this "generational" thing you want to espouse is not productive or helpful. Everybody works. Everybody, if they are lucky, gets old. These days, more of us are lucky and that's a good thing. And we all should be working toward the goal of providing for caring for each other.

I don't see how a good progressive can espouse otherwise.

[cuke]

184. Not only not productive and not helpful, It's also not true

You won't reduce the costs of long tern care by denying people insurance for long term care. Those patients still need the long term care. Someone has to pay for it. If the patient can't, their children will.

Insuring these people won't increase the cost of long term care. It only spreads the risks around. That's what insurance *IS*

[lapislzi]

194. Sadly, there's another alternative that nobody wants to talk about

Elders without means will simply die sooner. That's the way it is for most of us now anyway. If we can't afford the care, or the insurance, we must live with our ailments and probably die sooner because of them. It's a chillingly simple equation, and one that smacks of social darwinism. The rich survive and remain healthier.

[lastliberalintexas]

92. No, I think we should stop waging illegal wars of choice

and take profit out of healthcare entirely. Would you then still care about the old people who can pass something on to their families? Why are not as outraged and spamming the board with posts about the outrageous cost of nursing homes and assisted living centers?


Are you really that outraged about the idea that some middle class people might be able to leave their families a paid for house upon death? Do you honestly think that the truly wealthy would be impacted in the least by such a program? Do you honestly think that the truly wealthy go to the same facilities as you and I? Should the time come, Barbara Bush won't be going to the Shady Oaks Retirement Village with your grams. She'll be going to a posh, exclusive country club of a nursing home that probably costs more per month than I make in a year, and which currently isn't covered in Medicare/Medicaid anyway. Heaven forbid they accept federal funds, as then they wouldn't be able to discriminate and keep the riff raff out. So really, just what the heck are you truly so outraged about? Because I personally don't get it. :shrug:

[CountAllVotes]

84. do not confuse MEDICARE with MEDICAID

Medicare does not pay for long-term nursing home care (a short stay is allowed however). After that, you are one your own. Then, when you are indigent, you qualify for Medicaid which does pay for "in-home support".

My late mother fell ill w/cancer and she had to be put in to a 24-hr. care facility. She had insurance (2 types) and guess who paid the bill? I did.

:kick:

[supernova]

87. That's what I mean

Medicaid. Thanks for the correction.

But I don't think either of them provides for ongoing in home nursing visits, right? I.e., you can manage at home but need someone to check your stats, or wound care, and administer meds you can't take yourself.

[CountAllVotes]

90. Medicaid does

Medicare does not.

So, you are better off being flat broke and indigent if you are in a situation where you need help and are alone and/or need assistance.

[lovuian]

59. yes just how Europe and Canada does it

why any different??? Medicaid takes care of those in Nursing home already

[pnwmom]

69. How do they do it? n/t

[Skidmore]

62. I believe we need to start once again to value the role of the

extended family, and encourage people to step up and care for their parents, providing them with incentives for doing so. If you are going to "value family" then value it at both ends of life. Not just when you have an infant or small children, but when you have parents and grandparents who deserve attention. Now I realize that some families will not be able to do this for various extenuating reasons, and for those individuals, this type of care will be essential. We could greatly reduce the cost of care and the need for care facilities if familes once again served their original function--a support structure for one another.

[pnwmom]

65. One thing that makes that harder is how far-flung many families are.

Though I think it's a wonderful idea. I'm crossing my fingers that at least one of our children stays in our general area. Otherwise, we'll probably have to move closer to one of them someday.

The other possibility that has occurred to me is that a brother or sister could move in with us eventually -- haven't mentioned that yet to hubbie, though! It's just a thought . . .

[lapislzi]

79. Good luck with that pipe dream

I wish it could be so. These days, every adult is required to work at least one job just to keep body and soul together. Even in an extended family, there is no wiggle room for a nonproducing adult to stay at home to care for an elder or a child. That is the sad reality of the world we're living in.

I kept my grandmother (who suffered from dementia) home with me until my husband left me. Then I had to go out and get a job. Guess what happened to Grandma? Sure, there were cousins, even cousins nearby...but everyone had to go out and work. Nobody could afford to stay home and care for Grandma.

[Skidmore]

86. Which is why we need to reclaim our rights as workers

and demand roles to participate in this economy beyond that of slave and consumer. We need to regain control of our trade agreements and to insist on fair trade. By doing so we regain control of our lives.

[lapislzi]

97. Agreed. But that's one tall order.

And I will probably not live to see it, despite my best efforts.

[Cleita]

71. Yes, because families need help with this.

And those who don't have families definitely need help. I was sole caregiver for my husband. The job was 24/7 for seven years. I could have used some help. After he died, I collapsed with a variety of ailments, one after the other. It took me a couple of years to gain my health back. It might have been more cost effective if I had gotten help and then not gotten sick that required a lot of treatment and cure.

[lastliberalintexas]

96. Bless you Cleita

And finally, someone with personal experience pointed out the stress and problems of being the caregiver. It isn't the bed of roses that some people seem to think.

[bobbolink]

119. NO compassionate nation would allow people like you to suffer in that way!

I"m so sorry about the toll it took on you, and it was so very unnecessary.

We've become a nation of a lack of empathy, to allow this to go on.

Whether it's "cost effective" or not, no human being should be pushed to that extreme.

Not in the richest country in the world!

:hug:

[librechik]

74. of course n/t

[spinbaby]

78. I read once that in China...

...they have a program in which fit retired persons provide help--laundry, shopping, and such--to elderly who need it. Then, when they need help, they get credit for the hours they spent providing help and get that much help for free. Won't replace nursing homes, of course, but I think it's a very sensible plan for people who just need a little help to stay independent at home.

[dorkulon]

88. Hell yes. nt

[lapislzi]

102. This is why I reserve the right to take myself out at any time

I have told my family as much. If I begin suffering from dementia (yes, you know when you're suffering from dementia. It's a fallacy that people don't realize what's happening to them. Anybody with any intelligence knows, and it's terrifying. Before she totally lost it, my grandma confided how awful it was to know your "self" was slipping away) I reserve the right to check myself out. I will not bankrupt my husband or daughter or force them to stick my carcass in a for-profit facility where I'll be left stewing in my own Depends for hours because of staffing cuts. Nope, nope, nope. Let me go out in my own way, in my own time, clinging to a shred of dignity.

We need assisted suicide clinics.

[CountAllVotes]

108. We need assisted suicide clinics.

I agree with this statement!

:kick:

[lapislzi]

114. I know a few people for whom gift certificates are in order!

When you care enough to send the very best :evilgrin:

[bobbolink]

117. I think the alternative is relegating them to an ice floe... and they're becoming more rare, too.

Yanno, Dr., it would be wise and prudent to ask for MORE, rather than less in terms of coverage.

Not only does that raise the possibility of actually getting MORE coverage, but it also serves to provide some bargaining space. We know there will be lots of things tossed out... we might as well go for the whole enchilada, right?

We should also go for coverage of "alternative" medicine, as there are many things not really well dealt with in standard Western medicine.

I talked at length with a Canadian woman who worked for TEN years to get midwifery included in the Canadian system, and she kept making the point that it's much easier to get it included at the very beginning, than to try to add to it later.

[LittleClarkie]

149. Well, there's always nursing home medicaid. But then you have to be poor to use it.

I had to get rid of my dad's life insurance and sell his car so that I could qualify him for medicaid (called Title 19 in Wisconsin)

But not every nursing home will take Title 19. They won't tell you that outright, because they're supposed to accept it, but they'll keep you on a waiting list forever. They want the person to cough up out of their savings first. There are some games you can play, like taking things out of your name and putting it in your children's name, that sort of thing.

My dad still had to pay all his income to the nursing home to help offset the cost of him staying there. It wasn't medical so much as custodial care. Social Security and his pension both went to the nursing home, with him keeping $130 of it a month. Every year I went in to get him requalified for the program. And when he died, I had to take what was left and give it back to the state.

It was a huge hassle, and toward the end there, not something I really felt like having to do.

It would be nice if someone like my dad could get into a nice nursing home relatively close to where their family lived and not several miles away (I drove 25 miles a day to go and see my dad each day) without worrying about being denied because you're not wealthy enough to pay them for a couple years out of your own pocket.

[hedgehog]

151. Absolutely; anything else is a "Life Tax"

Right now we get to play the reverse lottery; you have a 1 in 4 chance of ending up in a nursing home and being forced to spend down a life time's assets before getting government help. You will spend down your assets quickly and I think most people end up under goevernment care. Effectively, it's a 100% tax on everybody in that situation as opposed to the so-called "death tax" on the rich!

[kineneb]

157. don't know how much residental care is...dialysis _is_ $23K per month!

and it is currently covered by Medicare, and other expenses can be covered by Medicaid if one is poor enough...

what is needed, along with single payer universal healthcare, is a sliding scale to pay for long-term care. Those who can afford to pay- should; as a percentage of their assets/income. Those who have few assets should pay accordingly. Right now, one has to spend down ALL cash assets, and often declare bankruptcy to get any kind of long-term/chronic care.

I know this because we had to spend down all our assets (life insurance, IRA, etc.) to get Hubby healthcare before he became disabled. Afterwards, we then had to declare bankruptcy because there was no way to pay off our debts. I am now looking at a future of poverty, especially after Hubby dies (possibly within the next two years).

on a dialysis forum a writer pointed out that people on dialysis are either very rich (and can pay or have insurance) or are very poor (to qualify for assistance)... no family can remain "middle class" once a member is on dialysis- the expenses are just too high.

[InkAddict]

185. We have been impoverished

as a result of dealing with an elderly parent w/ESRD at the same time that IT outsourcing hit its stride. Don't misunderstand, we found new jobs in a new city, for now, and still have our health, our kids, our pets, and our Internet connection, so we have much to be thankful for at this time. Still, the burden of caregiving is a huge problem for "only children" that quickly wipes out savings and stifles many hopes and dreams for the future.

My FIL would not accept that he was not going to get well. He was not well-educated but was a WWII vet who worked himself up to blue-collar management over the 47 years he was with his company. It was difficult to communicate with him because he could not hear even w/hearing aids, and he knew how to bluff a conversation even though he did not understand what was said. If his son had been able to stay employed, Dad may have been able to remain in Assisted Living until he passed. It was a deal at $2,300 a month plus. He had to sell his home, but he made many friends among his doctors, the residents, and the staff who thought he was a teddie bear/saint as he was always ready to help to a fault. He made lovely cute crafts and just gave them away to everyone he met. We did the best we could to give him the dignity and quality of life he deserved.

Now, with the savings gone, the home gone, and only a few years to go before SS kicks in, if my statements from SS are correct, I have absolutely no doubt that we will not be so lucky and pray we'll just drop over quickly when the health goes too to save our children from a similar fate. I'm fairly certain that the "powers that be" will have an even uglier surprise up their sleeves to steal away anything we might possibly be able to save against the day we are no longer employable. I fear that some, probably folks like us, will fall through the cracks of a transition to universal care, yet it needs to be done for all our children's sake.

[cuke]

186. I'm on the way to impoverishment

even though my mother has insurance up the wazoo, including long term care insurance

[sutz12]

189. The cheapest plan is to cover everybody for everything...

That way, everybody in the tax base is covered and paying into the system, assuming they're paying taxes. :)

[cuke]

190. Yes, Some people don't realize that these people need treatment, insured or not

Having insurance isn't going to increase the cost of treating these seniors. They need the treatment whether they have insurance or not. It's not about the cost of treatment; It's about INSURANCE which spreads the risk around.

[defendandprotect]

192. Of course . .. . in the long run we profit as a nation . . .

Many families have been destroyed trying to take care of people with Alzheimer's ....strokes . . .
whatever . ..

Personally, I want my family to take me out of it if I'm a veggie --
I'm counting on them!!!

But, for others, yes, yes, yes . .. .

[Vinca]

195. A humane, compassionate country would care for people who

cannot care for themselves. Sadly, the people with the ability to filibuster votes and veto bills, only care about themselves. They beat their chests about how Christian they are, but forget the parts of the Bible that deal with those less fortunate than themselves.

[lapislzi]

196. Yes, you can be assured

That the moms and dads (and probably their dogs, too) of senators, representatives, and administration officials will receive the finest care MONEY CAN BUY. F-U-J, I-OK.