On Wednesday, The Republican House voted to repeal a portion of Obama’s healthcare law called the Community Living Assistance Services and Support program which was intended to provide affordable long term care insurance for the elderly and the disabled. This part of the 2010 healthcare law has been in trouble for some time with Health and Human Services Secretary, Kathleen Sebelius acknowledging that the program known as the CLASS ACT, which allows workers during their working years to buy insurance, that provides them with a daily cash benefit for home healthcare, could not be made financially sustainable and in the long run would add greatly to the national debt. While the repeal measure may get stalled in the Democratic Senate, the program is considered by most to be another ill-fated attempt to fund long term care for the disabled and the elderly.
The cost of long term care in assisted living facilities and/or in nursing homes is so expensive that few families can afford to pay for it themselves without risking bankruptcy. In order to avoid destitution, there are legions of lawyers and estate planners that specialize in advising the elderly and their families on how to legally transfer their assets so as to be able to qualify for Medicaid, the government program that will pay for long term care in the nation’s nursing homes, but only for the documented poor. The cost of long term care in expensive nursing homes is therefore a huge burden on Medicaid, which will increase exponentially with the aging of the Baby Boomer generation.
One solution that has been offered by the private insurance sector is long term care insurance that pays for long term care in assisted living facilities and nursing homes for those that can pay the long term care insurance premiums. For most middle class families who are struggling to pay their household bills, health insurance, college education costs for their children and trying to save for retirement, paying the premiums for long term care insurance is not an option. In view of the losses suffered by families in the recent years of recession by dropping home values and savaged retirement accounts, long term care insurance premiums are all the more difficult to be able to afford; even for those that were in a position to able to afford them just a few years ago. And for those thousands of seniors who had planned to sell their homes to raise the monies needed to enter an upscale continuing care retirement community that typically charge an entry fee of several hundred thousand dollars and monthly maintenance fees, the recent huge drop in house values has taken that option off of the table.
The one sensible alternative solution to expensive long term care in an assisted living facility or in a nursing home is “aging-in-place”, i.e., allowing the elderly to remain in their homes for as long as possible. Unfortunately, even the cost for private help in the home, even part-time assistance on a continuing basis, can become financially unsustainable for many seniors. Spouses provide assistance when able as do extended family members, however in many cases the spouses are no longer physically able to be caregivers and family members live far beyond commuting distance from their elderly relatives. Indeed, the National Institute on Aging estimates that there are now about seven million long distance caregivers and the number is growing as more and more young people have to move away from elderly relatives to wherever they can find work in this post-recession economy. So for all the seniors who are not wealthy or cannot afford long term care insurance that pays for home health care, what solution is there to this ever growing financially devastating long term care crises?
One possibility may be in self-help. If there is a way seniors can provide themselves with affordable help in their homes akin to the kinds of help that they would receive in assisted living communities they can avoid these costly facilities altogether and also shorten the length of time they might need to be in even more expensive nursing homes. The more time seniors spend in their homes and the less in nursing homes results in a direct savings for taxpayers by lowering Medicaid costs and decreasing the nation’s debt. AARP surveys reflect that 90 percent of all seniors over 65 years old want to remain in their homes as long as possible. A current self-help movement to accomplish just this that is gaining momentum is the known as the “Village Concept.” This approach to long term care began in the Beacon Hill neighborhood of Boston in 2002. Over the past decade about twelve thousand seniors have created “Villages” in their own communities; mainly in the Eastern and Mid-Atlantic States. A simplified explanation of the concept is that neighbors join together in a non-profit corporation. Each pays an affordable yearly membership fee of about seven hundred dollars and agrees to be part of a network of volunteers providing help to fellow members who need some assistance in order to be able to remain living in their homes. Examples of such help include doing the shopping to providing rides to the doctor and doing simple home-care duties around the house and yard. While health experts have long warned against seniors doing strenuous caregiving tasks, new Boston University research shows that light caregiving duties improve both senior cognitive and physical functionality. Indeed the Sloan Center on Aging and Work estimates that 30% of the home- care workforce will be comprised of women 55 years of age and older by the year 2018 up from 22 percent in 2008. One national private home-care firm currently employs over 26,000 women 60 years of age and older. For more extensive and arduous work needed by their membership, village organizations screen, select and negotiate discounted rates with a full assortment of handymen, suppliers and vendors, including home healthcare providers, that would not be otherwise available to homeowners trying to negotiate with vendors on their own.
In addition to the membership fees and to keep them affordable, villages obtain additional funding thru grants and donations in cash or in kind. In many cases those who work as managers and directors of the day to day activities waive their wages in whole or in part. There are also new public and private sector programs that support the village concept of aging-in-place in one’s own home and neighborhood. For example AARP and the National Association of Home Builders have created a program where builders, architects and tradesmen can be certified as aging-in-place specialists by being trained to design, modify and remodel residences to be senior friendly. There are also federal grants to fund NORC or Naturally Occurring Retirement Community programs. NORC funding for communities with high concentration of senior citizens provides resources to create partnerships between local public and private organizations to provide aging-in-place support services and to educate their seniors on how to access those services. Such an aging-in-place program in Verona, New Jersey entitled Verona LIVE provided a one hundred thousand dollar grant. Verona LIVE through its local partners provide a wide array of support services to their seniors ranging from one on one computer lessons by local middle school students to a home maintenance program offering safety inspections and minor home repairs to having access to the services of a social worker.
The recent vote by the House of Representatives should send a clear signal to our elderly that if they want to solve their long term care needs that self-help may be one of their few options. The Village Concept provides an alternative for those who want to avoid institutional long term care facilities because they cannot afford them or because they prefer to stay in their own homes for as long as possible. Because all of the existing village organizations are so new it is not clear yet whether they are financially viable in the long term. However, the boomer generation now joining the ranks of the elderly may be a boost to the concept’s viability. Boomers are an independent-minded generation whose huge numbers alone will demand the vetting of all of the long term care choices, including those of aging-in-place as exemplified by the Village Concept. Village supporters welcome that challenge and believe that their model will appeal to the boomers who have never settled for the traditional in anything and will not do so when it comes to the choice of their mode of lifestyle in their golden years.