Donna Taylor鈥檚 father was the rock of the family. He was the primary caregiver for his disabled wife and her elderly mother. But he got sick and went into the hospital for 10 days. When he got out, he couldn鈥檛 walk.
Taylor, 41, and her siblings 鈥� all of whom had families and children of their own 鈥� helped out. But with three elderly, disabled adults in one house, caregiving got expensive. Taylor says her father was surprised at how quickly the family went through its savings.
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鈥淗e said, 鈥業 worked and I did the right things. I had a pension and I put money away in savings and I had what I thought were the right insurances and the money didn鈥檛 go far enough.鈥� It just, it just wasn鈥檛 enough.鈥�
When Insurance Isn鈥檛 Enough
Like most Americans, Taylor鈥檚 parents believed that Medicare and their private health insurance would pay all the costs of living in a nursing home. It doesn鈥檛. Medicare, the federal health insurance for the elderly and disabled, paid the full cost of her father鈥檚 first 20 days in a rehabilitation nursing home for therapy to try to get him walking again.
But Medicaid, the state and federal insurance program for the poor, does pay for someone to stay long-term in a nursing home. So Taylor told her father he鈥檇 have to spend through the rest of his savings, go into poverty, and qualify for Medicaid.
鈥淚f you have ever had to look in the eyes of a 64-year-old man who has now had to live in a nursing home, and it鈥檚 horrible,鈥� she says. 鈥淎nd he never ever made me feel bad about that decision. He never said, 鈥楧onna why鈥檇 you do this to me?鈥� But he told me, 鈥楾his isn鈥檛 how it was supposed to work out.鈥欌��
Taylor鈥檚 father died in that Phoenix nursing home last year. The nursing home is part of Arizona Baptist Retirement Centers, where Taylor works as an executive vice president. Taylor thinks her father sort of gave up on life.
Better Options
Proposals written into health care overhaul legislation would help families like Donna Taylor鈥檚, says John Rother, of the AARP.
One would encourage states to offer more generous benefits to disabled and elderly people on Medicaid who want to stay in their own homes.
And then, says Rother, there鈥檚 something that could help millions of people. 鈥淭he CLASS Act,鈥� he says, 鈥渨hich was introduced by the late Sen. Ted Kennedy, is a way of putting into place, gradually, an insurance approach to long-term care as opposed to the welfare-based approach we have today.鈥�
Workers would choose whether to have money deducted from their paychecks. The deduction would, on average, come to about $65 a month and, when needed, it would pay about $75 a day, according to estimates by the Congressional Budget Office. That鈥檚 a little less than half of what one day in a nursing home costs now.
鈥淭he CLASS Act is not designed to protect people from the cost of nursing home care, very expensive care,鈥� says Rother. 鈥淚t鈥檚 really designed to help you stay independent at home and to get the services you need: home care, Meals on Wheels, visiting nurse. The kind of thing people do need very often to be able to continue to live independently, and, you know, I think that鈥檚 actually what most of us want.鈥�
Debate Over Cost
How much the CLASS proposal would cost is still under dispute. The way it鈥檚 written, it鈥檚 supposed to pay for itself. How much gets paid out depends on how much is collected from those voluntary payroll deductions. But Frank Keating, president of the American Council of Life Insurers, says that鈥檚 wishful thinking. 鈥淚t sounds good in principle,鈥� he says. 鈥淏ut it is a huge unfunded liability.鈥�
The CBO estimated that the CLASS plan would reduce the federal deficit by $58 billion over 10 years. That鈥檚 why it has a good chance of ending up in final legislation. But Keating says those savings come in the early years when the money鈥檚 being collected and that it鈥檚 going to cost trillions of dollars when people start needing the benefits.
A Hard Sell
Keating represents companies that sell private long-term-care insurance. Fewer than 10 percent of older people have bought one of those private policies. It鈥檚 been a hard sell.
Still, Keating argues it鈥檒l be even harder to get young people to buy into the proposed public plan. 鈥淚t assumes young people will purchase this insurance from the government for a need 40 years down the line,鈥� he says. 鈥淭hat simply isn鈥檛 going to happen. Young people aren鈥檛 going to do it unless they鈥檙e mandated to do it, and they鈥檙e not mandated to do it in this bill and they should not be.鈥�
There hasn鈥檛 been a lot of high-profile debate about the proposals to add long-term care to health overhaul. The reason may be a reflection of the way Americans tend to think about getting old: It鈥檚 something best not thought about at all.