By John Geyman, M.D.
Providing personal and compassionate long-term care for aging seniors and people with disabilities has been a challenge over the last 100 years in this country. It has become much more of a challenge in recent years for a number of reasons, including its unaffordability even for well-off families, the lack of insurance to cover its costs, the aging of our population with increasing prevalence of dementia, mobility within families, the large number of people with disabilities, and the critical shortage of caregivers.
The markers of a growing crisis in long-term care are stark – by 2035, U.S. seniors over age 65 will outnumber, for the first time in our nation’s history, the number of children under age 18; the odds of developing dementia by age 85 are approaching 40 percent; more than one-half of U.S. seniors are expected to need long-term care (LTC) help with activities of daily living in their later years; and one in four Americans has some type of disability, most commonly with mobility, cognition, and/or being able to live independently.
Despite this looming crisis in long-term care, we still have no national plan to make it accessible and affordable. Long-term care insurance has become a relic of the past, Medicare provides little coverage, and Medicaid only covers some costs after the patient has spent down to a poverty level.
What to do about the U.S. health care system was a big issue in the 2016 election cycle, and promises to be even more so as the 2020 election campaigns battle it out over future health care. It is an open question whether or not most of us will be able to afford long-term care when we need it, whether for our parents, our children, or ourselves. Will there be a safety net for us when we get there?
This book examines, in three parts, the big, largely unaddressed challenge of long-term care: Part I: What are the problems?; Part II: How did we get here?; and Part III: What can be done?
The U.S. remains an outlier among almost all advanced countries without a system of universal coverage of health care. It is my hope that this book will help voters and legislators to better understand policy alternatives , and to support what will best meet the needs of all of us for the care that we will all need, sooner or later.
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By Don McCanne, M.D.
The growing crisis in long-term care, as John Geyman describes, seems almost insurmountable, but, as he explains, it doesn’t have to be so. Although it will test our nation’s dedication to solidarity, we can ensure that we each have the best quality of life attainable under the given circumstances in our infirm years in spite of the trying circumstances that many of us will face. In “Long-Term Care in America,” John Geyman tells us what can be done to help ease the tasks and tribulations for us and our caregivers.
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