Long-Term Care in the USA - Essay Example

Long-Term Care The current of the long-term care system of the United s has been brought about by the forces stemming from the combination of demographic, socio-economic and cultural factors and of the policy directions or choices that the government, both at the state and federal levels has chosen to follow in response to long-term care issues. Although long-term care is not limited to the elderly, as long-term care is also needed by anyone who need assistance in every day living as a consequence of disability regardless of age - disability happens more often in those who are older, specifically if they reach the age of 65 and up (Johnson, Toohey and Wiener 1). The aging of America has helped to bring the issue of the state of long-term care system in the limelight. It was in 1988 when Presidential candidates talked in their debates for the elections while Congress first tried decisively to cobble a national policy on long-term care by introducing four major bills on long-term care financing (Kuchler 1). However, while America is aging, life expectancy has also lengthened so that more and more older people are joining the ranks of senior citizens - consequently, expanding the ranks of those who will face disability in the near future. In the past, the policy was geared towards institutional care, mostly nursing homes and residential care facilities, but now efforts are being done towards more a home-based or community-based care due to the wishes of the families of patients. Another socio-cultural force that has brought the long-term care system to its current state is the role played by informal caregivers, especially women. Women and relatives of the elderly and the disabled have traditionally been assigned the task of being the caregivers of the family. As a result of higher educational attainments, rising divorce rates, and more opportunities for women in the labor force, the long-term care system has been faced with the issue of dearth of informal caregivers. Institutional care on the other hand, has also suffered due to the shortage of health care workers, - especially nursing assistants as a result of booming local economies, with other jobs such as fast-food restaurants paying better than those in the care-giving field (Stone n.p.). The shortage of care-giving professionals will continue to affect the state of the long-term care system in the future. Long-term care financing as well as delivery has been tasked as a matter of policy to Medicare and Medicaid, with the former including long-term care service only as an adjunct in case of acute illness for people with disabilities and the latter, as the institutional source of long-term care funding for very economically hard-up people. The policy has been criticized for failing to provide support for people who need long-term care service. Medicaid only could be relied on to provide long-term care when their financial resources have dried up and thus, "the system is excessively harsh" (Feder, Komisar and Niefeld 54). Partly the result of the inadequacy of the coverage of long-term care financing, most people especially from the middle classes rely on out-of-pocket expenses to pay for long-term care. It is estimated in one study that 20% of older people will spend US$25,000 from their own pockets to fund future long-term care needs (Johnson, Toohey and Wiener 2). There are continuing policy debates on how to integrate Medicare and Medicaid and how these debates will fare in the coming years and thus shape whether the long-term care system will be up to the challenge of providing better services and financially viable options for the country. As the age group called the baby boomers or those who were born between 1946 and 1964 reach retirement age and who currently comprise more than a fourth of the American population, some have sounded alarms that this phenomenon is a healthcare crisis in the making (Achison n.p.). When this age group will become part of the population that will stop paying taxes that fund Medicare and would be instead the population to be supported by the healthcare system, the heavy burden is seen to be shouldered by the nation, already saddled with inadequate and low-quality long-term care services. While baby boomers have benefited from medical advancements and are thus living longer than previous generations, the fact that they would expect to live well past the age of 65 means that they had greater chances of acquiring conditions that necessitate long-term care. One of the problems that would be facing the country as the baby boomers retire will be the shortage in nurses that will occur as older people would need nurses to attend to their needs - already a problem in the past and still is, in the present as more women become less inclined to take up nursing as a profession. In addition, there is also the shortage in caregivers that point to the fact that if raising salaries is not a long-term solution for the lack of health care professionals, then employing nurses and caregivers from other countries is the right solution. Another solution is that the country's policymakers should make long-term care financing available to those who are not necessarily poor but who are not as well off that they could afford to pay for expensive nursing care for instance. Policy makers should see that most people would like to see their loved ones taken cared off within home and community settings, despite the fact that most also would like to work so that they have better financial resources. Among other things, policy makers should make it a policy to ease the burden of long-term care somehow and recognize that most people would need long-term care regardless of income and occupation. This could be done somehow through tax exemptions for whose income are spent for long-term care or paid holiday leaves. Still another viable option is for people to take it upon themselves to prepare themselves and their loved ones in case of illness or simply old age necessitating long-term care through insurance. Although it is expensive, buying long-term care insurance will serve as a hedge that could protect assets from being depleted when costly services for long-term care hit. It is also better for people to buy this kind of insurance early so that premiums are still affordable rather than when one is older because premiums could be very costly. Among others, long-term care insurance is purchased according to those who are already insured because it is a way to "avoid being a burden to families, conserve assets for their heirs, to be able to get into the nursing home of their choice, to be cared at home as long as possible, to avoid Medicaid and to have peace of mind," (Long Term Care Insurance n.p.). On the other hand, some people decide against taking out a long-term care insurance policy because they find premiums too expensive. Moreover, long-term care insurance also does not take out the possibility that one may spend time in a nursing home, unless there are informal caregivers to pitch in help (Long Term Care Insurance n.p). Also, currently the return rate of long-term care insurance is at 60 to 65 percent which is way below than the return rate in other types of health insurance (Long Term Care Insurance n.p.). Yet, probably, as a matter of peace of mind and the health risks that are associated with old age, one will be better off with purchasing long-term care insurance. The trends that are apparent in long-term healthcare point to the swelling population of the elderly who are more liable to be disabled and with this, the bigger demand for long-term care services and delivery. In one study's projection, the older population will be growing faster than the younger age-groups (Johnson, Toohey and Wiener v). From 35 million in 2000, the number of older persons will reach 85 million forty years later. The 85 and above age group "which has the highest disability rate of all age groups" will balloon five times over by 2050 from just four million in 2000 (Johnson, Toohey and Wiener 1). Already, data from the 2004/2005 indicate that about 7 million older people in the United States have "difficulties with the activities of daily living (ADLs), such as eating, bathing and dressing, or difficulties with the instrumental activities of daily living (IADLs), such as housekeeping, using the telephone, and managing money" (Johnson, Toohey and Wiener 1) Another trend in the future is the projected shortage in informal care givers, due to low fertility rates since 1975 as women opt to have fewer children with increasing work opportunities. The percentage of "frail older people" with adult children to take care of them will decline in the coming years (Johnson, Toohey and Wiener 18). The implication for this is that more and more paid caregivers will be needed in the future to serve the old and disabled population, whether home-based or in nursing home environments. While higher educational levels are associated with lower levels of disability, still this means that Americans may only postpone the time when they would need long-term care. On the policy side, as the issue of health needs of older people gets more in the center of debate and focus, it is likely that more financial resources will be channeled to long-term health care. Already, Medicare and Medicaid expenditures for long-term care are on the rise especially with respect to coverage of homecare (Johnson, Toohey and Wiener 2). It is also likely that people would be more inclined to buy long-term care insurance to protect themselves from sudden financial burdens when a relative becomes disabled whether due to illness or old age. Works Cited: Atchison, Heath. "Baby Boomers: A Healthcare Crisis Nears". Experience.com. 30 September 2007. Feder, Judith, Komisar, Harriet and Niefeld, Marlene. "Long-Term Care in the United States: An Overview". Health Affairs. May-June 2000, Vol. 19 No. 3. Johnson, Richard, Toohey, Desmond and Wiener, Joshua. "Meeting the Long-Term Care of Baby Boomers: How Changing Families Will Affect Paid Helpers and Institutions". May 2007. The Retirement Project Discussion Paper Series. 30 September 2007 Kuchler, Joseph. "Congress inches toward a national policy on long-term care". September 1989. Healthcare Financial Management. 30 September 2007. "Long-term Care Insurance: How To Get the Best Deal" FSO Technologies. Stone, Robyn. Long-term Care for the Elderly with Disabilities: Current Policy, Emerging Trends and Implications for the 21st Century. August 2000. Milbank Memorial Fund. 30 September 2007. Read More