Opinion — The Big Pictures: Ignorance is not always bliss

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When it comes to paying for long-term care, many people just don't get it. Two recent developments suggest that this reality may be around for a while.

One is yet another stupefying vote by the Medicare Payment Advisory Commission (MedPAC). The other is a recent AARP survey.
In January, MedPAC recommended against giving nursing facility operators an inflation adjustment this year. Provider groups rightfully feel that such an omission would undermine the quality of care they deliver while failing to account for the full economic realities operators face.
MedPAC seems blissfully ignorant of a long-established reimbursement reality: Medicaid payments to providers are so inadequate that Medicare has had to help pick up the slack. MedPAC's parochial position appears to be: Who cares about the big picture? We're only concerned about Medicare's checkbook.
Fortunately, most lawmakers realize that to follow MedPAC's suggestion would be worse than folly. In fact, it could incite an industry-wide recession (or worse) and put many operators out of business. As an added bonus, the move might also reduce caregiving options for the nation's frail elders. Small wonder Congress routinely ignores MedPAC's counsel. But it is mildly irritating to watch this kabuki dance continue, year after year.
More disturbing than MedPAC's unique take on reality are results from a recent AARP poll. The association surveyed 1,456 Americans age 45 and older to assess their knowledge about the costs and funding sources for long-term care. The survey reveals that Americans are fairly clueless on both fronts.
For example, while 60% of those surveyed claimed to be "somewhat familiar" with long-term care services currently available, fewer than one in 10 (8%) could reasonably estimate the actual costs of nursing home care. Most came in way low, with some respondents guessing that such care would cost $500 or $1,000 a month.
Moreover, 59% incorrectly believe Medicare will cover nursing home care beyond three months for age-related or chronic conditions, while 52% incorrectly believe Medicare covers assisted living.
If this sounds familiar, it should. A similar survey was administered in 2001. Half a decade later, not much has changed.
So this may be as good a time as any to convene a national forum on the realities of long-term care financing. But let's limit attendance to two groups sorely in need of an education: MedPAC members and consumers age 45 or older. Both clearly need a reality check.
It's one thing for children to be naïve. But at some point, adults need to grow up.

John O'Connor is vice president, McKnight's Long-Term Care News
john.oconnor@mltcn.com
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