In a graying America, the cost of long-term care is a crisis: Expand Medicare to cover it Editorial: The wealthiest country in the world should have a reliable, uniform way to pay for care for disabled and elderly citizens. That would protect the nest eggs families spend decades building.

The Register's editorial | The Des Moines Register

You work hard all your life, save some money and look forward to retirement. Maybe you'll take up a new hobby, volunteer or just putter around the yard.

Then you have a massive stroke. Or a serious car accident. Or are diagnosed with Alzheimer’s. All your plans change.

Instead of taking care of grandchildren, you need a caregiver. Instead of bicycling with your wife, she’s pushing your wheelchair. The money saved for travel will be needed to pay for long-term care.

If you’re fortunate enough to have family, they begin the daunting task of finding a nursing home, assisted living center or in-home workers who can change catheters, administer medication, bathe and feed you.

This is the point when many Americans realize problems with the U.S. health care system extend beyond the outrageous drug prices, medical errors and insurance bureaucracies that most politicians focus on.

Long-term care is its own quiet catastrophe. Finding reliable care is as difficult as finding a way to pay for it.

There are too few qualified caregivers, largely because wages are so low. Private health insurance does not cover the cost of long-term care. Medicare pays for only limited stays in facilities after hospitalization; it does not pay for assisted living or adult day care.

And the expense is staggering.

In Des Moines, the median monthly cost for a full-time, in-home health aide is about $5,000, according to Genworth’s 2019 Cost of Care Survey. Assisted living is more than $4,300 per month, and a nursing home is about $6,700.

Democratic presidential candidate Pete Buttigieg understands the cost is a crisis for American families.

During a recent visit to Iowa, he talked about his father entering a hospital for the last time. The family was told the best option to cover the cost of needed long-term care was to spend down their savings until his dad was poor enough to qualify for Medicaid health insurance.

“I remember thinking, 'Is that how the greatest country in the world approaches long-term care? Is that the best we can do?'” Buttigieg said.

Yes, this is exactly how the U.S. approaches long-term care.

No, it’s not the best we can do.

The Indiana mayor’s policy proposal for long-term care includes establishing a cash benefit of $90 per day for seniors to pay for care in a facility or at home.

This is one idea for working within a fragmented health insurance system that forces our most vulnerable people into the poorhouse. It's also a familiar idea. Former U.S. Sen. Tom Harkin spearheaded a similar provision included in the Affordable Care Act nearly a decade ago.

The law created Community Living Assistance Services and Supports, or CLASS, a plan intended to allow working Americans to contribute premiums through payroll deductions and eventually be eligible for a daily payment to use toward paying for long-term care if needed.

But CLASS never became a reality. Meanwhile, the population is aging, and relatively few Americans have long-term care insurance, which comes with numerous caveats, including potential unexpected increases in premiums.

So what should this country do?

Congress should expand Medicare to cover long-term care services.

The government health insurance program for seniors and disabled people already covers prescription drugs, hospitalizations and doctor’s visits. It should treat long-term care as the necessary health service it is.

Yes, this will cost more. It may require increasing taxes and premiums, but it would protect the nest eggs families spend decades building, and it would save money in Medicaid.

Iowa’s $6.2 billion Medicaid program currently spends about half its budget on long-term care services in nursing facilities and on community-based supports, according to the Iowa Department of Human Services. And even those who can secure Medicaid may not find a nursing home willing to admit them.

It makes more sense for Medicare to include long-term care in its standard benefits. That would make the insurance truly comprehensive and set an example for private-sector health insurers. The government is a reliable payer and could increase reimbursements to help attract more caregivers to the field.

The wealthiest country in the world should have a reliable, uniform way to cover the cost of care for disabled and elderly citizens. Expanding Medicare could be the way.