Long-Term Care

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Long-term care can be defined as a broad set of paid and unpaid services for people who are mentally or physically disabled, or whose chronic illness places them in need of medical or personal assistance for long periods of time. “It is estimated that there are more than twelve million Americans of all ages whose mix of serious disability and chronic illness places them at the high risk for functional decline, hospitalization, or nursing home placement.” (Benjamin) Several different populations require long-term care services, and the needs of these populations vary. In addition to the elderly, many of the long-term care users are younger persons with physical disabilities; persons with developmental disabilities; and persons with chronic diseases such as diabetes, emphysema, and AIDS.

The increasing need for these services is creating significant budget concerns for Federal and State Governments, as well as straining family finances. Combined Medicare and Medicaid outlays have been growing dramatically. About 40 percent of long-term care costs’ are paid by the Federal/State Medicaid program. (Feder, Komisar, and Niefeld) Although the Medicare program accounts for only a small share of total expenditures, its share has been growing. Despite rising Government expenditures, out-of-pocket payments continue to be a large source of financing for long-term care. As a result, for many individuals who have chronic care needs, long-term care remains a catastrophic cost.

Contemporarily, long-term care has become a topic of focus in the U.S. for several reasons. The clearest reason for its emergence is that people live longer than they used to. The population swell after the World Wars, the “baby-boom era,” along with a higher average li...

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...n is expanded social insurance. This is seen as an alternative to public support for private insurance. Medicare could be expanded to include long-term care, entitling all, regardless of income to some insurance protection should they become impaired. This may sound good, but is not feasible. Despite the nation’s prosperity and underlying wealth, our willingness to redistribute resources to reflect the aging of the population seems to be highly unlikely.

In conclusion, better support for the economically disadvantaged has to be a priority in future policy. Private long-term care insurance must be available to all, whether tax subsidized or federally backed; long-term care coverage must be equitably distributed. We now expect people to impoverish themselves completely before providing them assistance with long-term care, and that system seems excessively harsh.

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