ElderLaw Answers Blog

The financial insecurity of the economic downturn has moved more Americans to value the financial security offered by Social Security, according to a poll recently released by the National Academy of Social Insurance.  While  President Bush could not get much traction even in good economic times for his efforts to privatize Social Security, it looks like he would get even less today.

According to results of the poll, conducted by Benenson Strategy Group, 88 percent of Americans say that Social Security is more important then ever in light of the current economy.  At the same time, they’re worried about the program.  Ninety percent are concerned about its ability to pay benefits to future generations and 44 percent of non-retirees are concerned about it being there for them. 

In what appears to be a new coming to terms with reality, the poll reports that three quarters of respondents agreed that workers should contribute more to the program if necessary to preserve it.  We can hope that this signals a change from the promises of many politicians that American citizens could get something for nothing which have contributed to our nation’s personal and shared budget deficits.

Why is it that opponents of health care reform prefer scare tactics and disruption to honest debate on the issues?  A case in point is the claim that the bill would encourage seniors to commit suicide.  Not true.

The House version of the bill would provide seniors the option of consulting with their doctor on “advance care planning” every five years to discuss their preferences should they become seriously ill. 

Dr. Muriel R. Gillick in a column in today’s Boston Globe explains that while most seniors say that they would like to have end-of-life consultations with their physicians — 89 percent according to one poll — very few actually have such discussions — just 17 percent in the same poll.  Why not? 

The reason is that doctors say they don’t have the time, and they don’t have the time because Medicare does not pay them for having such discussions.  All the House bill would do is to authorize payment for such important discussions between physicians and their patients.  As Dr. Gillick explains:

• The reason it is important to have the conversations is that death is not optional.  What is optional is how we will experience life’s last stage:  Will we be in an intensive care unit or enrolled in hospice?  Discussions about end-of-life care have been shown to result in patients experiencing less depression, less pain, and less anxiety in their final days.

Why do opponents of health care reform distort the facts to deny this care to America’s seniors?

Last week, I interviewed Suzanne Mintz, President and CEO of the National Family Caregivers Association.  She had a wonderful suggestion for all families with aging parents: hold family conferences, both to plan for the future and in the event of an illness or disability.

All too often, misunderstandings occur due to different family members having different and incomplete information.  Often, some family members feel overburdened and are afraid to ask for help or don’t know what they can expect from siblings and other relatives.  Ms. Mintz recommends taking the following steps:

• Meet while everyone is healthy so that everyone can plan ahead and get proper estate and financial planning in place.
• If a crisis occurs, meet to share information and expectations and to divvy up responsibilities.
• Prior to the meeting, everyone should compile a list of what they want to learn and what issues they would like to cover.
• Prepare an agenda in advance.
• Meet in person if possible.  If not, use conference calling or video solutions.
• Use a facilitator, usually a geriatric care manager or an elder law attorney.  But it’s possible that family friends or clergy can serve this role.
• Write down and share any decisions that come from the meeting.
• Hold as many meetings as necessary.

By taking these steps, a lot of misunderstandings can be avoided and no single family member needs to feel entirely alone and overwhelmed.

In a column on the Kaiser Health News website, Howard Gleckman, a Senior Research Associate for the Urban Institute, calls for getting Medicaid out of the long-term care business.  He points out that at more than $100 billion dollars a year, Medicaid pays for about 43 percent of the cost of home and nursing home care.

But it was never designed to do so.  It is the social safety net program for people who are poor and do not have health insurance from other sources.  Unfortunately, for those who do not have long-term care insurance, no health insurance currently covers long-term care, not even Medicare.  As a result, Medicaid has filled the gap, but at great costs to the states who share the cost of Medicaid with the federal government, and at great cost to seniors who must spend down their life savings before they will qualify.

As an elder law attorney who has spent more than two decades helping seniors and their families negotiate the morass of complicated and conflicting rules about Medicaid coverage of nursing home care, I could not agree more with Mr. Gleckman.  Let’s have national long-term care insurance, whether as a new program under Medicare or as an expansion of Senator Kennedy’s CLASS Act, and get elder law attorneys out of the business of helping middle-class seniors qualify for Medicaid.