How Do We Care for the Elderly?

Linda Chavez

Last week, the Obama administration dropped one of the signature provisions of its healthcare plan. The CLASS Act (Community Living Assistance Services) was intended to provide affordable insurance for long-term care to individuals who, because of infirmity or age, could no longer care for themselves. But the reality that not enough healthy Americans would sign up to make it self-supporting finally doomed the program.

Many opponents of Obamacare will no doubt cheer this turn of events because it confirms the view that we cannot afford to, in essence, nationalize health care. I agree --but I also recognize that the problem that the CLASS Act was trying to address is a legitimate concern for which we now have no workable solutions.

The nation faces a looming crisis in caring for the elderly, whose life expectancy often exceeds their ability to live independently. Millions of Americans need long-term care, but we currently have no system that adequately provides it a cost that most Americans can afford.

This topic holds more than public policy interest for me. Three years ago, my then-87-year-old mother came to live with me when it became clear that it wasn't safe for her to continue to live on her own. Although in good health, my mother is virtually blind and quite frail. She values her independence, prepares all her own meals, has excellent long- and short-term memory and follows the news avidly. But without daily assistance, she could not shop for food, get to the doctor or clean her own living space.

Last week, however, her situation changed dramatically. After returning from a doctor's visit, my mother fell on the last step of a steep climb down from the car to our home. I was just a few feet away from her when I heard her hit the floor. In that instant, her life and future changed dramatically. She broke her hip -- the scourge of the elderly -- and within 24 hours had undergone partial hip replacement surgery. Three days later, she was released from the hospital.

Medicare provides coverage for up to 100 days in a rehabilitation facility so long as the patient needs daily services that can be provided only by a doctor or nurse or is receiving the rehabilitation therapies provided and making progress. But when the 100 days are over, the patient is on his or her own. My mother is now in an excellent rehabilitation center in Boulder, Colo. -- but it's unclear what will happen when she's released.

If you're very wealthy and can afford upwards of $60,000 a year in private, long-term care, the alternative of an assisted living facility is available. But what if you don't have those means? I would gladly take my mother back into my home, but I don't think it's feasible for her to continue to live there. If we can manage to get her down those same steep stairs and into the house again, she'll be trapped there indefinitely, unable to go to the doctor, grocery or anywhere else except to the hospital if she falls and injures herself again. And she'll need someone with her 24 hours a day.

Since my mother has never owned a home or any other assets -- only a meager Social Security and Veterans' pension and the help I've provided since my father died -- she is eligible for Medicaid. And unlike Medicare, Medicaid does provide coverage for long-term care. But having visited the local facilities that accept Medicaid, I can tell you the decent ones have long waiting lists -- a year or more -- and the ones that don't have waiting lists break a daughter's heart. I simply cannot imagine putting her in one of these crowded, dreary, hopeless places.

Currently, 40 million Americans are age 65 and older, and of these, nearly 6 million are 85 years of age or older. One in 5 elderly Americans are currently considered dependent, but the proportion will grow to nearly 40 percent by 2050. We continue to expand the frontiers of life expectancy, but we have yet to figure out how to care for our ever-growing population of older Americans.

The administration's failure to come up with a feasible plan to solve the problem is no cheering matter. We must find a way -- not only for our parents but for all of our sakes.