Problems With Long-Term Health Care in America

The term "long-term health care" can refer to care within a private home, day programs that provide activities and meals for physically impaired persons, around-the-clock care at a nursing home, or assisted living for senior citizens. Americans who need long-term health care face a number of challenges, including the cost, quality and availability of care. Avoiding problems associated with long-term health care can require advanced planning and investment.

Cost

• Typically, long-term health care comes with a high price tag. Medicare can pay for nursing home care, but typically does not cover the costs of home care. Medicaid programs can pay for nursing home care, but typically require beneficiaries to exhaust their personal assets before offering coverage. Private supplemental Medicare coverage (often referred to as Medigap) varies, depending on the type of policy. Select Medigap policies can cover needs such as home care costs, assisted living expenses, nursing home costs and adult day care, but at a high premium cost. Long-term health care insurance policies vary in coverage and can carry a price tag too high for many consumers. For lower premiums, consumers must obtain long-term health care insurance when they are young and in good health. Americans often pay for long-term health care needs with their own funds, exhausting assets before Medicaid contributes.

Quality of Care

• Americans who need long-term health care might find services below the quality level they expect. Home health care aides often work for low pay, with inadequate training. Select states require home health care companies to obtain a license, but others do not, resulting in unregulated agencies offering care. Consumers searching for home health care services often do not check for certifications by Medicare, the Commission on Accreditation of Healthcare Organizations or Medicaid, and, subsequently, receive substandard care. Nursing homes participating in Medicaid and Medicare programs must submit to yearly inspections, while non-participants do not require the same level of scrutiny. Consumers searching for nursing home care can check with local consumer affairs organizations, the state ombudsman that oversees long-term care, Medicaid and Medicare to learn more about issues relating to specific health care agencies or facilities.

Availability of Care

• New developments in medicine, social structure and types of families have led to a higher need for long-term care facilities and professionals. Epidemics and chronic diseases, such as HIV/AIDS, cardiovascular disease and diabetes, have strained the long-term care system, resulting in a higher number of people in need. Consumers searching for long-term care might have difficulty finding exactly the care they need. While some small communities might have nursing home facilities, home health care might not exist, leaving those in need without care or in inappropriate care facilities. While primary health care coverage has come to the forefront in legislative agendas, long-term care often remains a lower priority in community planning. Long-term care often falls on family members who do not have adequate training or the abilities required to meet the level of assistance needed.