Here There and Everywhere

The 49 million people who care for older family members were hidden in plain sight, as usual, quietly shouldering a burden that so often takes a heavy toll on their finances and their physical and emotional well-being. Many of them — I know a few — are opposed to the new health care law, even though it includes one of the most important steps ever taken to improve caregivers’ lot, especially those of the middle-class persuasion. Of course, hardly any of them are aware of that.

The Community Living Assistance Services and Supports Act, otherwise known as CLASS, provides for a national insurance program to help cover the cost of long-term care — something 70 percent of people over 65 will need at some point along the way. The premiums will be much lower than those for private plans, and you won’t get screened out because you’ve already had some health problems. Once vested after five years, enrollees unable to care for themselves will be able to claim cash benefits for as long as needed.

Joe Raedle, Getty Images
A health aide helps a patient at his home in Miami. The new health care reform law could “transform long-term care” and make it possible for more patients to stay at home, said the chief of the National Council on Aging.
If you’re rich, you don’t require much financial help with long-term care. If you’re poor and can no longer fend for yourself, Medicaid pays the bills, often at a nursing home. For the rest of us, long-term care — at home or in an institution — now requires that we, or our caregivers, choose from among some unpleasant options.

We can spend down our retirement savings until we’re eligible for Medicaid funds. We can protect our savings by taking out expensive long-term care insurance — it costs my wife and me more than $5,000 a year. Or, depending on how dependent we are, we can throw ourselves, or be thrown, on the mercy of our families.

My friend — I’ll call him Frank — was a retired lawyer and in great shape until four years ago. He had just turned 90 when emergency surgery laid him low for months on end. Then his sight and hearing began to go. “I’m one of the lucky ones,” his wife, Helen, told me. “His mind is fine. But he can’t get around on his own — he falls, even with a walker. He can’t make a cup of tea or shower by himself.”

For now, Helen can afford to hire an aide for a few hours a day to help with Frank and allow her to get out of the apartment. “James gives me a life,” she said. The future looks darker.

Surveys show that 90 percent of Americans want to age at home. Frank is no exception, but he never signed up for long-term care insurance. “If I couldn’t keep taking care of him, I don’t what I’d do,” Helen said. “If he went into assisted living, it would use up all our money. It’s very scary.”

CLASS, one of the legacies of the late Ted Kennedy, offers caregivers and care recipients another option. “If it’s successful, if a large enough number of people sign up, it will transform long-term care,” says James Firman, president and CEO of the National Council on Aging. “It will create a market-based economy for keeping aging people at home.”

That’s an important “if,” since the program, by law, must be self-sustaining. Premiums will generally be collected as part of workers’ payroll deductions unless they opt out. The younger the worker, the smaller the premium.

There is a vicious circle built into the current arrangements. Many caregivers must hold down a job and maintain their own separate family household while also watching over an aging parent. That kind of pressure can have consequences.

In recent studies, workers 18 to 39 years of age who were caring for an older relative had significantly higher rates of hypertension, depression and heart disease than non-caregivers of the same age. Overall, caregivers cost their companies an extra 8 percent a year in health care charges and many more unplanned days off.

In other words, the strains of family caregiving can hasten the caregiver’s need to be the recipient of care.

CLASS bids to crack if not break that vicious circle. Its benefits would make it much simpler and less expensive for families to make sure Mom gets the support she needs to be able to spend life’s endgame where she wants — in her own home. Good news for Mom, and good news for the future health of her caregivers.

In the last few days, I’ve conducted a poll of a dozen friends who have been closely following the health care reform debate. I wanted to find out how much they knew about CLASS.