Health Beat: Will Hawaii Help Pay For Long-Term Health Care?
Medicare doesn’t do it, and Medicaid does it only for the indigent. Maybe it’s time for state government to provide help for people as they age.
Two weeks ago my mother, Kate Kozak, was admitted to a hospital in Pennsylvania, where I鈥檓 from, for a medical emergency.
She is 78, has had breast cancer twice, heart problems, a disabling stroke a few years back and now newly-diagnosed colon cancer. She鈥檚 been through a lot, and this latest hospital stay has left her fairly debilitated.
Last week, she was transferred to a nursing home for physical therapy for as long as Medicare will pay for it, which depends on its听assessment of her continued need for specialized skilled care.
That鈥檚 probably going to be about 30 days or so, up to 90 if she鈥檚 lucky. After that, well, who knows? We haven鈥檛 worked that part out yet. But whatever we choose, it鈥檚 not going to be easy to pay for her long-term care.
Our family is definitely not alone. By 2030, one in five residents of the islands will be over 65. With age comes the increased need for additional health care services, and here in Hawaii, as across the mainland, many people just are not prepared for their 鈥済olden years鈥 or for the costs inevitably involved with aging in place.
Medicare doesn鈥檛 pay for long-term care. That鈥檚 a fact many people don鈥檛 realize. My own father was surprised when he found out.
The average monthly cost of a private room in a nursing home . And it’s听
So, what happens when older people who need care can鈥檛 afford it?
Medicaid pays for care for those who are poor, or who have exhausted听their assets to pay for their own care and are now eligible to have the government pay for their care needs. The rich? Well, for those with a lot of money, it鈥檚 not an issue. But what about everyone in between?
Right now, without long-term care insurance, there is no coverage for in-home or nursing home care, and seniors must pay for it themselves. Many just can鈥檛 afford it.
In Hawaii, caregivers already provide more than听$2.1 billion听飞辞谤迟丑听of unpaid care for loved ones. But with the increasing number of those who are older and in need, soon enough there won鈥檛 be enough caregivers available. Few of us can quit our day job to stay home with elderly parents, and even fewer can afford to pay someone else do to it.
Hawaii has a chance to be at the forefront of changing the milieu of long-term care by establishing a type of 鈥渟ocial insurance鈥 funded by a 0.5 percent increase in the general excise tax. Sen. Rosalyn Baker plans to for such a program in 2016.
According to Kevin Simowitz, political director for , this would be the first time in the nation that a state was bringing legislative action to a social problem that touches almost everyone.
The idea is this: The funds generated from the GET increase would be used to pay $70 a day for 365 days for caregiving services with no age or pre-existing condition exclusion. For any individual who has paid income taxes for 10听years or more, this benefit would be available to help pay for their care.
Hawaii has a chance to be at the forefront of changing the milieu of long-term care by establishing a type of 鈥渟ocial insurance鈥 funded by a 0.5 percent increase in the general excise tax. Sen. Rosalyn Baker plans to propose legislation for such a program in 2016.
Caregiving can be a full time job, so $70 a day may not seem like much. But in total, without even considering any inflationary increase, that鈥檚 $25, 550 that would be made available for care, wherever it is needed.听That鈥檚 a benefit that is not available anywhere else in the United States and we have a chance here in Hawaii to be the first to make it happen.
Who would use it? Well, for those seniors who need to go to adult day care, this could help defray the cost. For those who are home during the day and need help with bathing, or medication assistance, or even just a few days a week of听care while family members are at work, this could be a lifeline.
Consider this, the GET is currently paid on most items sold in the state, but also by our visitor industry. In fact, recent tax statistics have shown up to 30 percent of the GET is paid by those who live outside the islands. What does that mean for the rest of us? Long-term care costs could be supported not only by those who live here, but by our tourism industry as well.
Now, it鈥檚 not going to be perfect, and it鈥檚 certainly not a solution for everyone. Sure, many people will pay into the system a lot longer than others, and may not ever need the services provided. But it鈥檚 a place to start.
Rather than keeping the status quo, which relies on seniors to care for themselves if they have any means that make them ineligible for Medicaid assistance, this program provides an option that might help to keep people at home. There are no income exclusions. It provides money to hire certified professionals to help, especially with the more complicated medical tasks, or even with something simple like giving Grandpa a bath.
It鈥檚 like forming a state-based social security for long-term care.
According to Lisa Adler, field director for Caring Across Generations, this program would not replace long-term care insurance for those who have it, but would be an additional way to pay for the rising costs of care. It would be limited in scope, but might be just enough to help families get by and not have to make the hard choices of whether to pay for 听housing, food, medicine or private care for those in need.
If this system was available right now, someone like my mom would be able to go home from the rehabilitation center, and have money to help pay for a private caregiver. Then my 74-year-old father would not have to keep working to be able to afford having her stay at home with an aide.
My brothers and I have been doing our best to help pay for her needs, and we all know that she won鈥檛 live forever, but just having this little peace of mind would help our entire family as we face the same dilemma that many residents of Hawaii deal with every day.
It鈥檚 time to start a much-needed conversation on how to take care of everyone as we age, while providing a novel mechanism to help pay for care.
Without it, or something like it, our senior, along with their loved ones and families, will continue听to face tough choices about how to pay for the help they need.
