My Comments: It’s unlikely that I’ll be alive and well one day and dead the next. The more likely outcome is a decline that might first manifest physically and/or mentally, or both, followed by many months or years before the lights go out.
How many of you are willing to live the rest of your life with just a hope and a prayer that your end will be quick, painless, and cost nothing?
I spend time trying to teach others who are not yet retired that dying slowly is not cheap. It requires money, someplace to live, and people willing to look after you. Those folks are increasingly under pressure, as there are more and more of us, many of whom do not have the financial resources to make their days livable.
Running out of money in retirement, the most likely time when Long-Term-Care becomes necessary, is too common. Apart from the personal stress of needing someone to help you, what role should society play in this evolving problem?
Keep this in mind as the national discussion increasingly includes health care for all. We’re not just talking about people on the margins. We’re talking about the inevitability of our individual mortality and how that’s likely to play out.
What is the role of society when it comes to solving these problems? For millennia, humans have looked after the elderly. It’s built into our DNA. So do we now decide to push the elderly aside and hasten their death, or do we take steps to increase the resources needed to allow us to survive with dignity?
by William Haseltine \ Sep 6, 2019 \ https://tinyurl.com/yxz75tax
Bruce Chernoff was right when he told the Washington Post that the long-term-care crisis in the United States will be catastrophic. Our aging population and changing demographics mean that we are becoming a nation with substantially more older people in need of care and substantially fewer younger people to provide it. The Washington Post article, while frightening in its content, is a relief in many ways as it means that at last there is a beginning of a consciousness of what our future holds.
The fact is that the United States is rapidly aging and our healthcare system isn’t keeping up. This isn’t just an issue for the elderly, it’s an issue for all of us. There is a rising cost to living longer. People older than 65 account for a disproportionate share of healthcare spending, in large part due to an increasing prevalence of chronic conditions and an excessive dependence on emergency room visits and hospital admissions.
There are promising solutions to this problem, however. These solutions move healthcare outside of hospitals and into homes, with potential cost savings in the billions. The Center for Medicare and Medicaid Innovations recently launched a pilot project to see whether home-based care could reduce the long term need for hospital visits among those 65 and older, and lower costs to Medicare. Over the first year of the project, nine out of the 17 participating sites reported combined savings of more than $25 million.
To make the move, we will be required to build up our home care workforce. This is an important opportunity. The only reliable source of job growth in advanced economies is in healthcare, which includes home healthcare. There are a number of things we can do to create this new workforce:
We can create standard education programs that result in federally mandated and regulated certificates and licenses. Home care in at present unregulated and requires no license or training. If a country such as India can develop a successful six week training program for emergency care workers with high school degrees, we can do the same for home care here.
We can find ways to substantially increase the pay for home care and long term caregivers. At present these positions are poorly paid, with hiring and recruiting agencies often taking half or more of the caregiver’s salary for overhead costs. We can also increase social supports for workers who may be able to fill these roles.
We can include home care and home healthcare in proactive immigration reform and encourage those with the requisite training and certificates to move to the United States. Indeed, without the benefits of immigration, the United States would already be much worse off than it is.
We can actively recruit those displaced by artificial intelligence and automation to home care work. Personal care for the elderly and the disabled can never be replaced by robots or artificial intelligence.
We can take the Medicare pilot project a step further and reform Medicare, Medicaid, and other forms of insurance to include home care and home health care.
We can train the younger old to care for the older old – many a recently retired 65-year-old would have the health, energy, and knowledge to become an excellent caregiver for their older peers.
Moving healthcare into the home isn’t just good for those in need of long term care. It’s good for government. It’s good business. It’s good the American worker. And it’s good for other countries as well. The United States is just one of many countries facing a long term care worker shortage and we have the opportunity to be the model for others to follow.