Once again PBS goes out of it’s way to get the needs of our nations elders completely wrong.
On November 6 PBS published an article titled 6 tips for averting America’s looming long-term care crisis. There was nothing really wrong with the “six tips” at the end of the article except that I am not sure you would read them and come away thinking they offered serious solutions to either consumers or law makers. That being said, it is frustrating and puzzling that an organization of the size and stature of PBS would seem to work so hard at getting the basics wrong. About the only thing they get right is that we have an aging population and that it will provide new challenges. Here are the statements that got my blood boiling:
1. “Most Americans over 65 will need about three years of long-term care”. This is just a crazy pulled from the air statement. If that were the case we would need way more skilled nursing home beds today than we have. In fact, if anything we are seeing the demand for skilled nursing beds decreasing and I predict that in 5-7 years 1/3 of our total skilled nursing home beds will disappear. Even if they meant to include assisted living (and I hope they didn’t because, classifying assisted living as part of long-care would demonstrate an even deeper level of ignorance.) it is a preposterous number.
2. “Nursing home care runs roughly $72,000 per year, on average. Add it up and many Americans could be facing bills of $216,000 or more.” This is such a typical case of playing fast and loose with the facts. Sure, the average cost of private-pay skilled nursing is $72,000 but that represents less than 20% of the total nursing home population. Today the vast majority of nursing home residents have all of their paid for through the Medicaid program. Don’t get me wrong, there are some serious problems with the whole funding system, but we are not stranding people with quarter million dollar skilled nursing tabs at the end of their lives.
3. “. . . and contrary to popular belief, it’s usually not covered by Medicare” Again I am sure there are some people who think their entire skilled nursing bill will be paid for by Medicare, but I doubt most. We ought to be concerned about stories like this because it does not really help the conversation about our aging population. It is particularly telling that apparently neither American Health Care Association (AHCA) or LeadingAge the two groups that represent the vast majority of long-term care communities were consulted. There are lots things we need to struggle with, issues that are real problems including issues of cost and funding. Here is my question for you: If you had been asked to contribute, what would you have said? Steve Moran
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Suprisingly we actually meet up with quite a few people that think Medicare will not only pay for their skilled nursing but are also surprised to learn it does not pay for all in home nursing services and in home non-medical services. I could not come up with a statistic to throw out on how many this is but is is not at all unusual to have this come up in our intial phone conversation with the individual or their family.
Hi Steve,
I’m respectfully disagree with your criticisms of the PBS article:
* You can find data about the amount of years that the average person requires nursing homes care here. The PBS numbers were neither pulled from the air nore innaccurate: http://www.aaltci.org/long-term-care-insurance/learning-center/probability-long-term-care.php (There are other sources for this information too, but that’s all I could find with a quick google search.)
– I’m not sure why you wouldn’t consider assisted living long-term care when they provide assistance with feeding, bathing, toileting, dressing and so on.
– All of the people who are receiving assistance through Medicaid to live at nursing homes were required to go completely broke before they could get Medicaid, so while the vast majority of nursing home residents are on Medicaid, it’s because they’ve been driven broke by LTC costs.
Furthermore, home care and assisted living are also types of long-term care and those are quite expensive as well. The monthly average base-rent at assisted living is $3500 per month, and that does not include care fees.
– An NPR poll showed that 40% of retirees incorrectly believe Medicare pays for long-term care, which isn’t most but a lot.
Cheers,
Jeff
Hi Jeff:
I addressed in some detail the definition of long term care in the comment just before this one. But I want to say, that define any help that anyone who is over age 64 as long-term care is a big distortion of what it means to be over age 65, though I will admit it does make for sensational numbers.
You are mostly correct that before someone can qualify for Medicaid they have to be completely broke (there are some spousal benefits that make this not quite 100% accurate). But my question to you is this, why is that a problem. What you seem to be suggesting is that the government should be on the hook for an elders care so that upon death family members can inherit something and I guess this may just be a philosophically different view of the role of government.
COST
Home care and assisted living are not cheap, but honestly $3,500 in many cases actually does include care and is $116 per day and when you look at what is covered it is a pretty good deal. It would be tough to find a decent hotel for that price particularly if it included meals, laundry and transportation to say nothing of things like assistance with meds and bathing.
That being said, I do agree this is a big problem because many boomers will not have enough money to pay for assisted living in many states and it is something we need to be thinking about. But I do believe we will see some new AL care models that will create more affordable options. It may also require some seniors to move to lower costs states or regions, which is fair from ideal, but may be the only practical solution.
With respect to the NPR poll it is right and we would need to probe the poll a little deeper to see how meaningful it is, because Medicare does pay for some Long Term Care.
Steve
Hi Jeff:
I am teaching a class tomorrow morning (Wednesday) and won’t be able to respond, but I am not ignoring and should be able to respond tomorrow afternoon.
Steve
From LinkedIn Groups
Steve,
I’m not so sure that all of the statement are incorrect. Most people think Medicare covers everything–assisted living and skilled nursing.
By Lorie Eber
From LinkedIn Groups
This article uses such broad terms. The general population is unaware of differences in levels of care, has no idea of reimbursement or appropriate care pathways etc. The Independent/Assisted Livings are in the business of filling spaces and those lines become blurry. The economic downturn and recession have in large part reignited the “keep our family together under one roof” Plan. Under/Unemployed family members are now more available to care for aging/ill family members in exchange for the financial contribution the patient can make to the family unit. Examine this trend and then see where patients are “jumping into” the care line. I would bet the acuity level is much higher. Outcomes are much different.
By Karen Patterson
From LinkedIn Groups
If factoids are repeated often enough, even those that should know better come to accept them as truisms. Public officials and all too many not for profit organizations also use fear and exaggerate data to help raise funds…not to mention insurance companies that can now use these “facts” to support exaggerated claims. Thankfully, advocates like you may one day keep them honest…or I choose to hope so.
By G. Richard ‘Dick’ Ambrosius
From LinkedIn Groups
Talk about missing the mark and lack of due diligence… thanks for giving us more insight. It’s so important to understand what real needs are for families.
By Marcia Brown
From LinkedIn Groups
Greed. Ego
By Lynn Drummond, B.S, LNHA, RCFE, CGPS, RAC-CT
From LinkedIn Groups
Hi. I’m the editor of the Money and Work channels at Nextavenue.org, the PBS site that reposted the PBSNewsHour piece. The three-year statistic comes from the Dept. of Health and Human Services and appeared in this recent AP story: http://www.apnorc.org/PDFs/Long%20Term%20Care/AP_NORC_Long%20Term%20Care%20Perception_FINAL%20REPORT.pdf I also believe the nursing home and long-term care stats are accurate; the experts at the forum didn’t get into whether Medicaid or individuals might be paying these costs. It’s true that Medicaid pays some nursing home bills. It’s also true that many people don’t qualify for Medicaid and must shoulder their long-term care expenses. And survey after survey shows that the public is deeply confused about which government programs do (or, more likely, don’t) pay long-term care costs and that they believe Medicare covers far more than it really does.
By Richard Eisenberg
From LinkedIn Groups
I make presentations about care options and most people know very little about these issues, especially the financial aspects.
By Lorie Eber
From LinkedIn Groups
Like hunting at night without a flashlight !
By Paul Chaisson, MBA, LNFA
From LinkedIn Groups
Most of the people I talk with are very surprised to find out that medicare does not cover long term care. I do put assisted living along with memory care and personal care homes in the long term care grouping. People moving into these places are there long term. They do not expect to return home. As such Long Term Care insurance will often pay for assisted living communities. They will also often pay for in home care which can be another long term care option.
Gone are the days of nursing homes being the only option. Today society has choices.
By Kathryn Watson
The items you have cited are unfortunately superficial treatments of the topics, but not necessarily incorrect. The presentation should have dug in more comprehensively, rather that just presenting a statistic like that the average time that a senior lives in a nursing home is a little less than 3 years, which has been the basic statistic for at least a decade. That doesn’t make it incorrect; just shallow reporting that can mislead as to the potential much longer time — five, ten, even twenty years or more — that seniors may need substantial support in structured living arrangements, often including a series of stages with increasing levels of care provided.
By Martin “Marty” Womer
From LinkedIn Groups
If you haven’t had to think about these issues, you don’t know what is accurate. Many children of aging parents have to get knowledgeable very quickly and often it is very confusing as to what things cost and what programs cover various options.
By Caryn McCleskey
My response to Richard at LinkedIn
Richard I appreciate your clarifications, but here is why I continue to find the particle that you published frustrating and unhelpful:
1. What you and the government have done (at http://longtermcare.gov/) is to label every single bit of help with any activity of daily living to someone who is over 65 as long term care. So if I am 64 and have someone who comes into my house to clean once a week that is having a housekeeper. But when I turn 65 instead of being someone who has a housekeeper I am now someone who is receiving long-care. So I guess technically your 3 year number could be right. It is just not a very accurate or helpful way of looking at it.
2. On page 4 of the report is this footnote: “For the purpose of the survey, the phrase “ongoing living assistance” was used in place of long-term care and was defined as “…help with things like keeping house, cooking , bathing, getting dressed, getting around, paying bills, remembering to take medicine, or just having someone check in to seethat everything is okay. This help can happen at your own home, in a family member’s home, in a nursing home, or in a senior community. And, it can be provided by a family member, a friend, a volunteer, or a health care professional.”
This means that every time I call someone I know who is over age 65 and ask “How have you been?” I am providing Long Term Care. If you are trying to be sensational and pump your numbers to prove a point, I guess this is a way to do it. But honestly, it is demeaning and ageist towards people who are over 64 and live vibrant independent lives. It is so broad that it is meaningless.
3. In truth, if you work in or understand the senior care business at all, you will know and understand that most generally the term “long-term care” is understood to mean skilled nursing.
4. Finally, of the six tips from six experts, most of them felt that the government should do something. As first glance this may seem reasonable, but it ultimately means taking money from me, my children and my grand children to pay for the care of someone else. While it is clear we have some societal obligations to those in need, I don’t think it includes paying for elder care so their families can have an inheritance.
5. Finally and perhaps most puzzling is something I wrote in my article and that is that you did not include in the conference or the article the three trade organizations that represent the providers of senior housing and skilled nursing today.
Steve Moran
I’ve been on a cruise with only limited internet and so have missed this important conversation. I must confess that actuaries find it perplexing to see people throwing statistics around with little sense of the practical implications and then using their presumptions to develop public policy.
Our social insurance programs are forged in a political cauldron so they are more political than well reasoned, and it’s easier politically to provide benefits than to structure financial sound mechanisms for meeting needs. The classic example is the CLASS Act which was doomed to fail from the outset because it was more wishful thinking than practical reasoning.
Steve is on the right track here with his call for practicality before our nation loses its standing in the world as a sound currency bastion. The wishful thinkers didn’t like the practical wisdom of Alexander Hamilton but thank goodness that General Washington understood the importance of sound policies and he set our nation on a sound course. Let’s not now allow superficiality to lead us down a primrose path toward a debacle like that with which the Greeks have had to cope.
Actuaries, too, are human, but at their best they can bring an understanding of what works financially in a social sharing context and what is unfair and unjust. Let’s listen more to those who have some understanding of these matters and listen less to journalists and politicians who are symbiotically looking for the easy way to solve complex and difficult problems.
As President Obama conceded last week, insurance is more complex and than he and his advisors realized when they developed their policies. They would have done well to have included actuaries on their policy team.
Did you title this article for shock value and to be sure to get a response? Don’t attack PBS if you want to make a point and/or be a credible voice on behalf of seniors and their families. It’s truly not necessary. You do yourself no favors by attacking PBS, one of the most powerful positive forces in American life and media today with many loyal supporters (including me, obviously). This makes you look like an opportunistic provocateur. I’ll give you the benefit of the doubt and believe that you are more than that, but that’s how you are coming across. Just sayin’…
Hi Grace
I appreciate your joining the conversation, but I think when it comes to issues of elders PBS does not have a great track record of presenting a balanced view.
1. First headlines are always written to get people to read as was this one. That being said, I stand by my headline.
2. Going back, the PBS Frontline story attacking Assisted Living generally and Emeritus specifically was produced to be sensational and not to provide useful valuable information to consumers. In fact, I wonder how many people who live in fine wonderful assisted living communities went to bed worrying necessarily about their or their families safety. In fact, it strongly suggested that all or most assisted living communities are unsafe and uncaring. This is simply not true.
3. While there is no doubt that we may be facing serious cost issues relative to aging, what PBS did was to completely redefine common industry terms to create a more sensational story. I ask you, how is it right to suggest that if someone is over age 64 and has a housekeeper come in once a week or once a month it is long-term care.
All I ask of PBS and anyone who is writing about the needs of our aging population is that they paint an accurate portrait of the problem and redefining common terms for sensational purposes doesn’t do that. In your view, what did I actually get wrong in my article?
Steve
In my experience, most people do not know the difference between Medicare and Medicaid, and they do not know who pays for what. It is not an easy thing to understand, hence the need for seminars and workshops. I also believe most people think of “Assisted Living” as part of a continuum of Long Term Care. I think the PBS article is accurate as far as it goes. If I were someone just learning about LTC, I would not be distrustful of PBS. They have a good track record.
Hi Sharon:
You make a good point that most people don’t know the difference between the two payment sources and seminars and workshops are a great idea. I think PBS does have a good track record which is why I am so concerned when they don’t paint a full or accurate picture of things.
Steve
Steve,
I have debated whether to jump in, but after stewing on this for a while…here are my top two issues with your “PBS Misses the Mark” article:
1. Your article leads with how ‘PBS’ got the basics wrong. So did you. PBS is a distribution network, with member stations across the country. Some stations air almost entirely PBS distributed shows, while others purchase from a variety of sources and still others create their own content. What this means is that PBS distributes Frontline. They don’t control the content – that is the job of the producers of Frontline. Your beef is with them. That being said, Frontline tends towards the hard-charging, take-no-prisoners style of reporting…so they might enjoy seeing a bit of conflict over their report.
2. You ding ‘PBS’ for not offering serious solutions to consumers or lawmakers. That’s not their job. And if those of us who live and breathe senior issues 30,40,50 hours per week, year in and year out can’t offer serious solutions and concensus on senior care, (or even have complete agreement on the terminology we use) how is it remotely reasonable to expect TV producers to do so? Their job is to shed the light and get the conversation going. It’s our job to offer the solutions.
Best wishes,
Sally
Hi Sally:
I am glad you did jump in and you make some great points.
1. You are absolutely right about the PBS network and I would have been more accurate if I said actually The News Hour.
2. With respect to their job I only sort of agree with you. While I get that what they did was designed to create controversy and start the conversation, I feel they have some obligation to present the other side. I am not suggesting it needs to be balanced, but honestly there is not an industry or even medium to large organization that you could not create scandalous story about by cherry picking facts and antidotes. Even if the reporting organization disagrees with the opposing or differing view it should get some air time. If you look at the Emeritus story there was a guy who talked about training on the video and as I understand it, the video was edited to omit some clarification that would have provided a more accurate picture of what they really did.
Finally I don’t want to whitewash the problems or the industry. There have been abuses and problems and we as an industry can do more to clean up problems. I am really appreciative of the California Assisted Living Assisted Living Association who have gone to the state and proposed a 20% increase in licensing fees to improve the inspection and enforcement process.
Steve