From: cyanosis@igc.org (ADAPT)
Newsgroups: misc.activism.progressive
Subject: 03/92 INCITEMENT: THE PEPPER COMMISSION ON LONG TERM CARE
Date: 13 Apr 92 20:17:15 GMT
Followup-To: alt.activism.d
Organization: University of Missouri
Originator: rich@pencil.cs.missouri.edu


          THE PEPPER COMMISSION ON LONG TERM CARE

     In September 1990 a bipartisan, Congressionally mandated 
commission, chaired by Senator Rockefeller (D-West Virginia), 
produced a report on comprehensive health care.  It's purpose was 
to investigate health and long term care and recommend 
legislation to ensure health care and long-term care for all 
Americans.  Some of their findings are summarized below.

     Nearly 2 million people live in nursing homes.  66% of long 
term care users are 65 years or older, but 33% are younger. 36% 
to 45% who reach age 65 in 1990 will spend time in a nursing home 
before they die.  26% to 45% of nursing home stays are shorter 
than three months.

     On the other hand more than 5 million older people with 
disabilities and over 3 million disabled younger people live at 
home, or other non-nursing home residences.

     In 1988 the nation spent $53 billion on long term care. 
"ONLY 18% WENT TO HOME CARE - DESPITE THE FACT THAT FOUR OUT OF 
FIVE DISABLED AND ALMOST THREE OUT OF FIVE ELDERLY DISABLED LIVE 
AT HOME."  Almost 75% of severely disabled elderly (in 1989) 
relied solely on family members or other unpaid help. Four out of 
five caregivers average four hours a day seven days a week.  One 
third are older people, have incomes at or below poverty, or are 
in poor health themselves.  Most are women.  More than 10% report 
leaving jobs to provide care. For the minority who pay for at 
home care, costs are big. The most severely disabled report 
spending about $439 per month in 1982.

     Federal and state governments spent about $7 billion for at 
home services in 1988, (37% Medicare, 47% Medicaid and 16% 
federal and state grants).  Medicare is limited to people who are 
homebound AND need skilled or professional service. "Most people 
who need long term care don not need skilled services so Medicare 
is of little help.  A few states rely on Medicaid to pay for long 
term care to people with disabilities living at home.  These 
services are limited in amount, duration and scope, so "t he 
special waiver programs serve very few folks.  Title XX (20) of 
the Social Security Block grant program and the Older Americans 
Act fund some long term care with looser eligibility criteria but 
much fewer dollars for many purposes.

     Elderly people facing the emotional devastation of having to 
go to a nursing home must contend with financial devastation as 
well.  Those with $3000 out of pocket spending per year ($250 per 
month) spend 83% on nursing home costs. Medicare only covers 
nursing home care as part of health care, but not "the extended 
personal care that is the bulk of  nursing home services."  
Medicaid contributes 90% of public funding for nursing homes, 
over 40% of all nursing home revenues.  To be eligible for 
Medicaid services though a person must be "virtually destitute."

     Private long term care insurance is very new and very 
limited.  Policies are not sold to people who are already 
disabled, and may leave large gaps in coverage when care is 
needed.  Good policies are very expensive, the Health Insurance 
Association of  America reports a 65 year old will spend $1,400 
in 1990 and a 79 year old $4,000.

     This report, which is the basis fro several of the health 
care reforms being discussed today, recommends that long term 
care should be a right for everyone, but firmly supports a dual 
system of nursing homes and better home health services.
Newsgroups: misc.activism.progressive