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Elder Care After CoVid

The CoVID19 crisis has brought home crucial lessons for all of us who care about older loved ones and America’s senior citizens. Often, a senior has to be placed in a nursing home because of his or her medical conditions or financial circumstances. By their very nature as communal facilities that house older and infirm individuals, nursing homes are natural “hot spots” for both seasonal influenza and Coronavirus. Residents may contract Coronavirus due to their proximity to other residents who have it, or exposure to a staff member required to give hands-on care, or from some other disease vehicle. In this pandemic both public policy and a lack of emergency planning by nursing homes share blame for the high incidence of infection and death.

For example, some state governors (including, ironically, some who refer to seniors as “our most vulnerable population”) ordered nursing homes to readmit residents who had been in the hospital. In New York, this included seniors still ill with CoVID19! Ordering a resident to be readmitted to a nursing home often sets them up for failure because many homes are poorly staffed to begin with. Most of the time, the ratio of certified nurse assistants to residents is 1:12 or higher. This means that one nurse aide is responsible for caring for a dozen or more residents.

Some nursing homes have sequestered residents with CoVID symptoms to specific areas and required them to quarantine in a private room for seven to 14 days, which is extremely difficult for seniors deprived of human contact. Elsewhere, such sequestration is a safety measure that many homes cannot provide due to bed availability and spacing issues.

In some nursing homes, recently hospitalized residents have been denied readmission. I have also read of nursing home administrators asking family members to take residents home to quarantine. What can we expect in situations where relatives are required to take back a resident who had been brought to the nursing home because they couldn’t care for him/her to begin with?

One naturally wonders, if more seniors were able to receive care in their homes with the help of licensed, non-medical home care agencies, would the spread of the virus and the number of deaths among seniors be mitigated? My answer is, of course, yes! However, the cost of a caregiver through a licensed agency is about $29.00 per hour in the Chicago area. Here and elsewhere, 24-hour care costs more than $700 per day, and a live-in aide (many agencies no longer offer live-ins) costs about $300 per day. The cost of in-home medical/nursing care well exceeds $700 per day. With these sorts of daily costs, staying at home is not a viable option for many seniors and their families. (Note: some people choose to hire an unlicensed caregiver at a much lower price. But that option carries huge liabilities.) Surprisingly, Medicare supplements cover some helpful items (e.g., I was able to obtain for a client a motion-sensor that detects falls). Medicare does not, however, cover the cost of in-home care if it is custodial, and what is offered under Medicaid in Illinois is severely limited.

Those who can afford to age-in-place at home with non-medical home care provided by a licensed agency can do so because they have the funds to pay privately. Many seniors have to enter nursing homes that are Medicaid-friendly so that they can stay there for long-term care if the need arises and a Medicaid bed is available. The limited coverage bed that is offered for in-home care under Medicaid is just that – limited – and is not a solution for seniors who eventually need long-term care.

Many of my clients make the mistake of hiring a non-medical home care agency; as a result, they run down their finances over time, so that when need arises, they must go into a Medicaid nursing home immediately. And that sort of placement is very difficult.

Often, the nursing homes that will accept residents who have no money are not the best facilities out there. Therefore, the imperative to plan and save ahead – decades ahead – for one’s retirement years has never been more apparent.

Insurance companies have made some huge strides toward making the costs of long-term care insurance more manageable for average Americans. However, the new hybrid products still require an investment in life insurance with a long-term care rider that many people still cannot afford. In a perfect world, I envision a product that could be purchased at a child’s birth, whether it be offered through an insurance carrier, or some additional, optional tax deduction that accumulates as one grows older, and guarantees the individual a pool of savings to cover the cost of staying at home, at least for a while longer. Ultimately, there would be several categories of consumer: (1) Those with the cash to pay caregivers privately through an agency with their own funds; (2) Those who pay via the optional taxes to be withheld to ensure they have the money to stay home during their elder years; and (3) Those who must rely on Medicaid.

If we are to create a society where Americans can age in place, as healthy as possible for as long as possible, then we must be willing to embrace across the board policy changes. A reduction in tax burdens on individuals and families could go a long way toward easing the financial constraints that force many seniors to rely on care under Medicaid. Tax incentives for investing in geriatric services and building healthier senior living facilities would enable an industry now reeling from the global pandemic to rebuild itself for the 21st century. Tuition breaks and other incentives for young people who wish to obtain geriatric nursing degrees and study in fields relevant to elder care would help ensure that we have a robust senior-care workforce of the future. Currently, home health aides are poorly paid (e.g., $13.32 per hour) and such paltry compensation for often-difficult work does not attract a large pool of enthusiastic candidates.

Given the complexity of the legal, medical and regulatory issues affecting senior nursing care now and in the future, now might be the time for the formation of an inter-agency working group at the highest levels of the U.S. government to address the needs of America’s aging population in the “post pandemic’ world. The federal Agency for Healthcare Research and Quality aims to support research to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. The National Institute on Aging is commissioned to lead scientific efforts to understand the nature of aging and to extend the healthy, active years of life. The federal Elder Justice Initiative coordinates efforts by the U.S. Department of Justice to combat elder abuse, neglect, and financial scams that target seniors. Representatives from these agencies, as well as the National Council on Disability and the Medicare Payment Advisory Commission (MedPAC) – together with private sector experts like myself – would be well suited to examine and prioritize urgent policy recommendations for our elected officials.