Senate Committee Takes Aim at Long-Term Care

by David Gorn

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The numbers are scary, according to policy experts and legislators at a Senate Subcommittee on Aging and Long-Term Care meeting yesterday:

    • The cost of care in a nursing home in California is approximately $6,000 a month, and the cost of part-time, in-home care is roughly $1,700 a month, according to state officials.

    • Both those numbers are expected to double in less than 20 years to $12,000 a month for nursing home care and $3,400 a month for in-home help, according to committee Chair Elaine Alquist (D-Santa Clara). 

    • California has more than four million seniors right now. That figure is expected to more than double to 8.8 million by 2030, according to Steven Wallace of the UCLA Center for Health Policy Research.

    • About one-third of the respondents in a UCLA survey say they couldn't afford one month of nursing home care, Wallace said.

"Californians are financially unprepared for their later years," Alquist said. "Medicare doesn’t cover long-term care services. And long-term care insurance is expensive and few people in California have it."

A growing senior population in California will need a substantial amount of care over a long time and won't have the money or insurance to pay for it, most experts predict. That leaves Medi-Cal as the resource of last resort, Wallace said.

Given the current financial pressures individuals and the state are under, not much is likely to change and we are looking at a looming health crisis in California, Wallace said.

"When you're under the worst recession since the 1930s, that makes it hard to even think about long-term care," he said. "And in state policy, there has been a series of reductions already, such as SSI/SSP (Supplemental Security Income/State Supplementary Payment) reductions. And ADHC (Adult Day Health Care) centers are threatened with being closed Dec. 1."

Some Californians are turning to long-term care insurance, but that's weak porridge to Bonnie Burns of California Health Advocates.

"Long-term care insurance is often proposed as the solution to all of this, and that could not be farther from the truth," Burns said.

"You're talking about a private, profit-making industry. That won't take care of the people who need it most. You have to be young enough [so you're less of a risk], you have to be wealthy enough to pay for it, and you need to qualify," Burns said. "So if you have medical conditions, you're not likely to get it."

At the federal level, an insurance program called the CLASS Act (Community Living Assistance Services and Supports Act) was proposed and then shelved.

Most of the policy experts at yesterday's hearing lamented the loss of that program as a possible solution for the long-term care conundrum.

"I don’t think anyone has talked about an equivalent of the CLASS Act on the state level," Wallace said, "but I don't see why that couldn't happen."

"A CLASS Act for California, that would be a class act," Carroll Estes of UCSF said.

"That's good," Alquist said. "That's what I'm looking for here, some kind of actionable ideas."

John Shen of the Department of Health Care Services said the state has worked with the commercial health insurance industry to develop long-term care plans that are affordable and high-quality. "We have about 115,000 active policies now," Shen said. "And those policy sign-ups are growing at a pace of 10,000 a year.

Shen also noted that the state has a consumer education website to help Californians deal with long-term care issues.

Colleen King
Well, sounds like we're preaching to the choir here but care isn't going to get any less expensive as time goes on. And neither is insurance, especially as people get older, they lose opportunities for certain LTCi discounts or become uninsurable. The term 'personal responsibility' comes to mind, not that all can do it, but we have to start somewhere. The more we rely on government the more expensive it will get, and with less people able to contribute to 'the pool' of money, that hurts the rest of us.
Scott Olson
Most people overestimate the cost of a good long-term care policy. A healthy, married couple in their mid-fifties, can share a policy that starts off with over a half million in benefits for about $100 per month per spouse. Scott A. Olson LTCShop
Vladimir Yepishin
Different health conditions, culture and family values, and income status dictate to the deprived people that or those LTC insurance or its absence. Fortunately there is in California (as well as in many other states) the program that is right for majority of needy men and women. This is the Adult Day Health Care Program -- a licensed community-based day care program providing a variety of health, therapeutic, and social services. The program restores or maintains optimal capacity for self-care and prevents institutionalization (keeps the longest possible time the needy people in community and family setting).
Barbara Hanson
Profit-making companies are insuring everything I value--and that includes my LTC healthcare. CLASS proposed much higher premiums for limited, non-functional benefits than what an LTC insurance company charges. If you want a policy paying $75/day forever for a working, partnered 35 yr old, it costs $245/yr w/ current LTC policies, but as in CLASS, that would be useless for serious LTC need now and later. $1500 a year for a good policy w/ inflation is not "too expensive” when LTC can cost $1500 a week, doubling every 15 years. The State could better encourage the already functioning successful CPLTC program (private insurers + state guarantees) for the middleclass and wealthy. If half or more CA residents w/ assets and health realize their need to be personally prepared for LTC disability, get LTC insurance, or at least have a viable idea of how to finance need privately, then there may be enough state money for a better support program for those who are already unhealthy or poor.

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