Long-Term Care Features: The Role of Government in Elder Care

Medicare and Medicaid are the primary insurance available for many elderly Americans. More often than not, elderly people require some form of long term care (LTC) treatment. Despite the prevalent need, these programs do not adequately cover LTC, and so leave a major void for individuals reliant on their support.

Medicare covers LTC only when care is acute. It does not cover nursing home care at all. Medicaid will only cover patients in a Medicaid-approved nursing facility. There is no middle ground.

It seems integrating Medicare and Medicaid coverage would solve at least some of these problems. What occurs, since this is not the case, is the elderly are forced into devoting a majority of their assets towards continue essential coverage. Along with this comes a forced move to a nursing home in spite of the fact that they may still be in able physically and mentally to remain in assisted living. A nursing home, ironically, is twice as expensive as assisted living and thus costs the government more money.

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Insufficient Accomodations and the Olmstead Decision

Because elderly Americans have varying degrees of disabilities, long term care facilities need to be designed to suit the needs of these disabilities. A blind person would need a different kind of facility than an alzheomer's patient, for example. Few states organize care settings to suit the needs of qualifying individuals. One reason is that is a lack of funding.

This behavior was determined to have violated the Americans With Disabilities Act (ADA) in the Supreme Court decision known as the Olmstead decision. It determined patients were often placed in skilled care facilities when they would be more appropriately placed at home or in an other setting.. The decision was later overturned but it made an impact.

The Aging and Disability Resource Center, supplies grants to 24 states. With these grants, states have created community resource centers. These provide information and guidance about the settings and services available to the disabled and elderly for long term care. This type of service would, of course, be invaluable to the elderly who are seeking specific facilities with specific care.

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Medicare Eligibililty Issues

Currently, Medicare provides home health benefits to beneficiaries who require intermittent or part-time skilled nursing care and therapy services, and who are homebound. This was defined flexibly to include individuals who "occasionally leave the home." These services must be prescribed , (and re-certified every 62 days) by a physician.

Eligibility for both rehabilitation and long-term care hospital benefits from Medicare is physician-determined. Rehabilitation hospitals must demonstrate that 75 percent of their patients have at least one of ten specific conditions. Patients must require frequent physician involvement, 24-hour rehabilitation nursing, generally at least three hours of therapy a day, and a coordinated group of skilled professionals. In order for Medicare to cover rehabilitation hospital services, patients are expected to improve as a result of therapy. For long-term care hospital admission, Medicare coverage for inpatient services is included under the basic Part A hospital benefit.

Only the most basic elements of Long-Term Care are sufficiently recognized by government programs, which leaves most elderly Americans on their own for financial support. This creates a large financial hardship for even the affluent, and makes the need for supplementary insurance coverage all the more crucial. Do not put off your long term planning under the notion that the government will take care of you; rather take an active role in your future and prepare for yourself and your family with a Long Term Care insurance policy.

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