Professor Gets Out the Word About Long-Term Care

Posted: March 21, 2011 at 1:03 am, Last Updated: March 21, 2011 at 5:28 am

By Leah Kerkman Fogarty

Mark Meiners. Photo by Nicolas Tan

Very few Americans want to confront the reality that they may need assistance as they age. Yet long-term care is something that as much as 70 percent of people over the age of 65 will require at some point in their lives, according to the National Clearinghouse for Long-Term Care.

Mark Meiners, professor in the Department of Health Administration and Policy in Mason’s College of Health and Human Services, has devoted much of his career to developing long-term care programs that provide people with the means to pay for nonmedical personal care, such as help in dressing or using the bathroom.

“Most people, as they age and get frail and disabled, are going to have to have home and community supports to keep them in the home — or if that’s not possible, then they’re going to go to assisted living or nursing homes,” Meiners says.

“Long-term care, if you define it very liberally, is just something that any of us needs to get through our lives,” he says.

The Dollars and Sense of Long-Term Care

While the majority of older Americans will need long-term care, experts say that only about 10 percent of older Americans currently have some kind of long-term care insurance.

Meiners says part of this gap can be explained by confusion about what a person’s regular health insurance or even federal programs like Medicare actually cover.

“Many people think that Medicare covers long-term care, and it doesn’t. Many people don’t understand the differences between Medicare and Medicaid — Medicaid does cover long-term care, but you have to be poor to get those benefits,” Meiners explains.

With baby boomers — people born between 1946 and 1964 — hitting retirement age and beyond, the already thinly stretched public resources available will take an even bigger hit as the 76 million people in this generation strive to remain independent and in their homes for as long as possible.

“It’s important to have people prepare for this risk,” says Meiners, “because Medicaid is really not designed to be a middle-class, long-term care product. So if it becomes that, it will become something we cannot afford without major new taxes.”

Long-Term Care on the National Stage

Meiners prepares to speak at a health care summit on Capitol Hill. Photo by Nicolas Tan

Meiners has been studying the economics of long-term care since 1975, when he was an economist with the National Center for Health Statistics in the U.S. Department of Health and Human Services. From 1988 to 2004, he was the associate director of the Center on Aging at the University of Maryland, as well as a professor in its College of Public and Community Health.

Beginning in 1987, Meiners led the Partnership for Long-Term Care, an innovative state-based long-term care insurance program. Now 40 states — including Virginia and Maryland — have some kind of long-term care insurance program. This is a direct result of Meiners’ pioneering work in this field.

Meiners’ work has helped to bring the issue of long-term care into the national spotlight, as a provision in the 2010 Patient Protection and Affordable Care Act addresses the need for long-term care insurance.

The Community Living Assistance Services and Supports provision, known as the CLASS Act, is one of the least-known benefits in the new health reform legislation, Meiners says.

“The CLASS Act is a national long-term care insurance program that’s voluntary,” Meiners say. “It’s historic in the sense that we’ve never had any kind of national insurance for long-term care before.”

And while the landmark bill was passed almost a year ago, many details still need to be worked out. In fact, U.S. Health and Human Services Secretary Kathleen Sebelius admitted recently that the CLASS Act is not sustainable the way it is currently worded, and changes will need to be made before the law takes effect in October 2012.

Analyzing Options for Long-Term Care Insurance

Around the same time that Sebelius made her remarks, Meiners wrote a policy brief published by the Center for Health Care Strategies that outlines the differences between the CLASS Act and the State Long-Term Care Partnership programs. This brief points out some of the drawbacks of the CLASS Act that Sebelius has now alluded to.

Meiners explains that the CLASS Act, as it stands now, is open to all enrollees, even those who cannot qualify for other insurance due to pre-existing conditions. The CLASS Act is also a benefit that can last a lifetime, though it will pay out a relatively small amount, averaging $50 a day, to beneficiaries. Meiners calls this a “long and lean” structure.

This is in contrast to the state-run partnership programs, which have “short and fat” structures. Meiners writes in his policy brief, “Partnership coverage is designed for members of the middle class who are most at risk of spending their limited resources, then needing to depend on Medicaid.”

He points out that the average person who uses formal long-term care requires it for less than two years, so having a greater monetary payout for a shorter amount of time may make more sense for many people.

But Meiners does see a huge benefit in the CLASS Act, regardless of how its details may be ironed out.

“It gives more visibility to the issue,” he says. “It tells the public that long-term care insurance is something to consider.”


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