Today’s Florida Times Union contains an editorial regarding Alzheimer’s and an article about the impact on marriage that Alzheimer’s has for increasingly large numbers of people.  Together, the information provided by both exposes the impact that Alzheimer’s has financially, psychologically, and ultimately socially, on both individuals and our society as more and more Americans are afflicted with the incurable disease.

According to the editorial, there currently are 5.7 million Americans over the age of 85 who suffer Alzheimers.  By 2050 that number is expected to grow to 19 million.  In Florida there currently are 450,000 Alzheimer’s sufferers.  More than 10,000 baby boomers turn 65 every day now! One in 8 of them will eventually be afflicted with Alzheimer’s.

In the general population in America, only 4% of those over age 80 reside in a skilled nursing home.  For those with Alzheimer’s, 75% live in a skilled nursing facility.

It is estimated that the cost of Alzheimer’s to America over the next 40 years will exceed $20 trillion.  That’s enough to pay off the entire national debt and send ever American a check for $20,000!

Medical payments for Alzheimer’s patients over 65 average nine time higher than non-Alzheimer’s patients.

Staggering numbers.  Yet, we know of no treatment that slows or stops the deterioration to the brain that is caused by Alzheimer’s.

Toll on Families

The toll on families caused by Alzheimer’s is two-fold.  The first is psychological, as the Alzheimer’s patient steadily deteriorates.  The burden on all family members is great, but the impact on the primary care-giver is often overwhelming.  According to the Alzheimer’s Association, in 2010 caregives provided more than 17 billion hours of unpaid care (valued at $202 billion).  More than 80% of that care is provided by family members.  Caregivers experience unusually high levels of emotional stress and depression. Long term care planning can often alleviate some of the toll.

What should I consider when developing a long term care plan in Florida?
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Dealing with a spouse with Alzheimer’s creates another area of concern and adjustment, as detailed in the article:  “Alzehimer’s: Is this ‘until death do us part?’

When is a spouse no longer a “spouse” for purposes of marriage?  The article discusses evangelist Pat Robertson’s recent comment that Alzheimer’s justifies divorce.  It raises many questions, morally, religiously, and practically:  when has a spouse “died?”  Has “death” occured when the physical embodiment of a human no longer has a mind that functions?  Has the spouse with Alzheimer’s already abandoned the marriage through the death of memory and cognitive function that comes with full blown Alzheimer’s?

Clearly, the fact that the mind has ceased functioning doesn’t eliminate the need for the spouse’s physcial care.  The financial impact of the disease, if not provided to the extent possible through the spouse’s resources, will become an expense to society.  The follow up question is whether the cost to society should be borne by the local community or the national government?

That leads to the second impact on society which is the financial burden of Alzheimer’s.  Caregivers, especially family members, may give up their jobs, or reduce the amount of work they perform outside the home.  The cost of care, ultimately leading to transferring the patient to a skilled nursing home is significant – whether it be loss of income or lost opportunity.

According to the editoial:  “Families resist sending a loved one to a nursing home for financial and for other obvious reasons.”  Financial is often the overriding concern.  Currently the cost of a skilled nursing home for an Alzhiemer’s patient often exceeds $80,000 annually, in Florida.  How does the typical family cope with that kind of expenditure? 

Currently there are three sources of funds for paying for such care:  (1) private pay from personal funds, (2) long term care insurance, and (3) Medicaid – the joint state and federal program to provide medical care to the financially needy.

Private Pay

The major problem with private pay is that most families cannot afford to pay $80,000 annually, or more, to care for a family member, without effectively impoverishing the remaining family members.  Average household income across the country for 2010 was $51,691 per household, according to the U.S. Census Bureau.

Long Term Care Insurance

The President’s proposed long term care insurance program (a part of “Obamacare”) is officially defunct.  It’s final death was announced by the White House just this week. That leaves only privately owned long term care insurance.  The National Institute on Aging and Duke University have developed a National Long Term Care Suvey that provides much very detailed information about long term care needs.  The National Clearinghouse for Long-Term Care Information provides comprehensive information about paying for long term care. For more information on the impact of the abandonment by the Federal government of the CLASS Act long term care insurance program, and a discussion of how to pay for the long term care needs of financially needy families, see the article:  “CLASS is Killed: But How Will We Pay for Long Term Care?”

The short answer to the question of what role does long term care inurance play in providing Alzheimer’s care is this:  long term care insurance provides a significant role when the individual can qualify medically for its issuance, and can afford the premiums for the insurance.  The younger you are when you purchase long term care insurance, the more likely you are to qualify medically for its issuance and the more affordable the payments.  For most individuals long term care insurance is unobtainable or too expensive.


Medicaid

MEDICARE does NOT provide nursing home coverage (beyond a short period of coverage available for rehabilitation from injury or disease – 100 days).

Medicaid is the program that provides nursing home care for those who are unable to financially pay for such care.  There are a number of eligibility requirements for Medicaid benefits.  The most limiting requirements are those related to “countable income” and “countable assets.”  Funds for Medicaid are provided by the Federal government and are a significant contributor to the US budget deficit.  As more boomers reach the age at which Alzheimer’s becomes debilitating, the financial needs for the Medicaid program will become greater.  What cost will our society be willing, or able, to bear to treat Alzheimer’s patients who are cognitively impaired and without memory.  Again, very difficult issues, morally, religiously and practically.

Medicaid Eligibility Requirements
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Conclusion

Whatever your beliefs may be regarding these issues, they are issues that must be examined, and dealt with by all of us on an individual level, and by our country on a societal level.

What do you think?  Share your views.

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