Geriatric Care Management
Links to Sections of This Page
Medicaid Cuts | Private Insurance | Benefit Services
Growth of private long-term care insurance will expand the role of case management
by Robert E. 0’Toole, LICSW, BCD
The final outcome of the great budget debate of 1997 is now the law of the land..President Clinton signed the Balance Budget Act of 1997 into law in August 1997. It calls for drastic cuts (or a "reduced rate of spending") in both the Medicare and Medicaid programs. Specifically, savings of $100 billion is to be achieved over the next 5 years in the Medicare program.
An additional $9 billion in spending for the Medicaid program is to be eliminated during the same 5 year period. Critics of the funding changes for these two health insurance programs describe them as 'deep cuts' which will create disruption and difficulty for beneficiaries. Proponents of reduced Medicare and Medicaid spending prefer to describe their proposals as 'slowing the rate of growth' in these programs. Either way, the current level of federal and state funding for health care, and especially long-term care services, will never be the same.
Long-term care encompasses a wide range of medical and other supportive services to assist people who have difficulty performing basic activities of daily living (ADL's). A person who needs help and supervision for an extended period of time with such tasks as bathing, eating, dressing, toileting, bowel and bladder continence, mobility. and transferring from a bed to a chair, needs long-term care. The need for such care can suddenly follow a stroke or a serious heart attack.
Other disabling conditions. such as Alzheimer's disease, Parkinson's Disease or severe arthritis can have a slow progression requiring increasing levels of care over time.
Despite attempts to reduce or slow the growth of health care spending for elders, the need for such spending is expected to grow substantially. Over the next 25 years, institutional and non-institutional long-term care expenses will triple(1).
Home health care expenses alone are projected to increase from $7.9 billion in 1990 to $19.8 billion by the year 2020. According to a 1994 study entitled Aging America, "Unprecedented numbers of Americans are living to old age. As a result, the nation faces important decisions about the care of vulnerable and frail older people(2).'
Another report, recently released by the Bipartisan Commission on Entitlements, predicts that unless major changes are enacted soon, spending on health care, social security and federal pensions will consume the entire federal budget(3).
Medicaid cuts could eliminate long-term care financing
Medicare has never paid a substantial share of long-term care costs - between 3 and 8 percent by most estimates. Medicaid, on the other hand, has been a major source of long-term care financing. The reductions now being proposed in Medicaid spending are, therefore, viewed with alarm by elder advocates. Steve McConnell, of a group known as The Long-Term Care Campaign, recently stated 'long-term care for the elderly and people with disabilities faces a serious threat.
Congressional leaders have proposed Medicaid cuts that could eliminate long-term care for 1.74 million people by the end of the decade.' McConnell, who also serves as senior vice president of the Alzheimer's Association, claims that 'Congress is discussing cuts that would force states to reduce their long-term care expenditures by as much as $37 billion through the year 2000(4).'
Senator William Cohen of Maine, former Chairman of the Senate Aging Committee and now Secretary of Defense, has declared that. "The U.S. must not create any new, unrestrained, non-means tested programs for long-term care." Instead, Cohen calls for the encouragement of "personal responsibility among middle and upper income Americans to prepare for their own long-term care needs."
Private Long-Term Care Insurance
"The private market," says Cohen, "has tremendous potential for financing long-term care. But", he continues, "many falsely believe that health insurance or Medicare will cover long-term care expenses(5)".
Cohen and others have proposed incentives to encourage the purchase of private long-term care insurance. These include allowing a tax deduction for long-term care premiums, as well as allowing states to exempt a person's primary residence from Medicaid liens if the owner has purchased an approved long-term care policy(6).
Tax deductions for those who purchase private long term care insurance became effective in 1997 and several states, including Massachusetts, have adopted regulations that exempt a person's primary residence from Medicaid liens on their home.
It is estimated that more than 12 million Americans will need long-term Coordination benefit, which the company claims is 'unique in the industry(7).'
Many long term care policies now offer a care coordination benefit to help policy holders make the most effective use of their benefits. For example, at no extra cost those who purchase a Traveler's long-term care insurance policy may use their benefits to pay for coordination of services at both the insured's option and through a care coordinator of their own choosing.
If the claimant used the care coordination benefit, Traveler's will extend Home Health Care benefits to include a privately hired home health aide. The Care Coordinator must then arrange for the services of a Certified Nurse Aide/Home Health Aide.
Most long-term care insurance policies are issued with a deductible or elimination period. This elimination period, during which no benefits are paid, typically ranges from 20 to 100 days, a choice the insured makes at time of application. Since care coordination benefits would be used before receiving benefits, payment for the care coordinator starts immediately upon meeting the ADL triggers. In other words, no elimination period needs to be met to use the care coordination benefit.
Services provided by the care coordination benefit
According to Traveler's marketing department, the care manager may perform the following functions for the client:
- Certify that the individual meets the benefit triggers for assistance and care.
- Develop a care plan or 'prescription' for services to meet the needs identified in the assessment; arrange and coordinate professional and community services with family.
- Ensure that Medicare, other coverages, and community-financed services are used.
- Provide ongoing monitoring and customization of services to accommodate changing needs.
- Counsel and educate family care givers.
- Serve as the client's advocate. (This is especially valuable when the client's family/children do not live nearby.)
At this time, the number of long-term care insurance polities in force remains small, but is growing steadily. The amount of claims activity to date is still only a fraction of those who hold such policies. The anticipated growth of private sector financing for long-term care, and the increased recognition by insurance companies of the important role which case managers can play in the delivery of long-term care, is a positive trend for case management professionals.
Robert E. O'Toole, LICSW, BCD is a professional geriatric care manager and long-term care insurance specialist in Dedham, MA. Contact him at P.O. Box 428, 450 Washington Street, Suite 108, Dedham, MA 02026-0428, Phone 781-461-9637 or fax 781-461-9638 or email bob@elderlifeplanning.com.
Sources
- Aging America: Trends and Projections, joint study by the Administration on Aging, the Senate Special Committee on Aging, and the American Association of Retired Persons, 1991
- "LTC: Current Issues and Future Directions." - General Accounting Office Report, 1994
- Ibid
- "Some Cuts Never Heal", Long Term Care Campaign, April 1995
- US Senate Aging Committee hearing, April 1995
- Ibid
- General Accounting Office Survey, 1994
If you have further questions, please take advantage of our free consultation service - this allows you to determine whether Long Term Care insurance is appropriate for your own personal retirement plan, at no cost or obligation.
Simply give us a call at 781-461-9637 or send us your questions via our Feedback page - we are independent Long Term Care specialists.
Our goal is to help you determine if you need and are qualified for this protection, and only then to assist you in selecting the company, the amount and type of coverage best suited for your particular needs.
To receive a FREE Caregivers Information Kit, send us a request.
Promote Your Eldercare Practice in:
The National Elder Life Professionals Network
A comprehensive, interactive directory of independent elder life planning specialists. Experienced professionals who provide an array of services to older adults, non-geriatric disabled adults, family and professional caregivers and employers and employees concerned about the stress of caregiving and work life.
For more information about the Directory, email bob@elderlifeplanning.com
Informed Eldercare Decisions, Inc., provides the following services:
- Health, social & functional assessments to determine the services best suited for each individual.
- Care Planning and care management: arranging & monitoring home & community care, assisted living, nursing care facilities & other services.
- Support for family caregivers who live far from their parents or siblings.
- Advisory services to guardians and conservators.
- Counseling and assistance with methods of financing the high cost of long term care including: Long Term Care Insurance, Reverse Mortgages, Life Settlements and other long-term care financing strategies.
Informed Eldercare Decisions, Inc. is a private company dedicated to helping people make the best choices for long term elder care of their relatives. We are Experts in Long Term Care insurance and Elder Care planning.
450 Washington Street, Suite 108, Dedham, MA 02026-0428, USA
Phone 781-461-9637
Fax 781-461-9638
|
