Balance long-term care needs with costs

Fourth in a series

Becoming a savvy consumer in the eldercare market takes research, time and common sense.

Given the difference between good and poor care, it's worth the effort. As I said in my last column, the steps we follow to buy a car show us the way to buy care. The first: Figure out your universe of choices — what's available? Today's focus is on the second step: Know the costs involved and how you'll pay.

With cars — because they're everywhere — it's easy to quickly "ballpark" your price range. A $90,000 new Lexus? A $5,000 used Subaru? Or something in between? Will you lease, get a loan, pay cash or keep taking the bus?

With eldercare, the cost is less well-known yet more important, because it's the gas (ahem) that makes the eldercare engine run — the No. 1 factor that determines its quality, your choices and how much control you'll have over what you get. I don't think there's anything more defining.

Does this mean you won't get an eldercare lemon if you pay Lexus prices? Of course not — if you don't shop carefully. But the reverse is more true: Most families assume Mom can get Lexus-quality care at little or no cost, and that it's hers for the asking. The government, health insurance or somebody else pays for it — right?

Wrong. We should know better. Where else do we expect to get something for nothing? The government's silence has aided and abetted the public's misunderstanding about this for decades, causing great harm, yet the silence continues.

I'll be the messenger you want to shoot.

Three government programs pay for limited care for disabled Americans, but none is as easy or as generous as most people think. Here's the reality.

Medicare covers two important health needs of older people — doctors and hospitals (and now prescription drugs), not long-term care. While it does pay for a tiny portion of home and nursing-home care, it does so only while you're being rehabilitated (such as from a broken hip) and then, only for a short time (say, three weeks). If you're not likely to get better quickly — and most older people aren't — Medicare won't pay a dime.

Medicaid is the "safety net" that provides long-term care services free for the very poor. It's part of the welfare system, run in our state by the Department of Social and Health Services (DSHS). It wasn't meant — ever — to pay for the care of people who can pay for it themselves. Yet it's assumed to be an entitlement program by millions of well-to-do families who either don't know or care about its dirty little secret: Medicaid pays rock-bottom prices. As a result, many care providers — especially in the Puget Sound area, where costs are highest — won't accept Medicaid. Those that do may not offer the quality you want.

The Veterans Administration pays for some long-term care, but priority is given to low-income vets whose needs are service-related. Most don't qualify.

So, if the government doesn't pay, who does? The answer: We do, just as we've paid for our cars, our homes, the food we eat — and everything else we've used all our life. It's not a fun way to spend our money, but it's the price we pay for having better living standards and medical care and, thus, longer lives.

So what are these costs? Well, much of it is free because families and friends provide 70 to 80 percent of all eldercare. But as a person's needs change, families often can't handle the relentless, intimate and unpleasant responsibilities that are required. That's when they turn to the professionals — the businesses and individuals we pay to provide care.

And it can be expensive. The Puget Sound area has the fourth-highest eldercare costs in the United States (the farther away you are from Seattle-Bellevue, the lower the prices). Here are some ballpark figures: $60-$80 for a companion or chore worker to help with shopping and meals for four hours; $120-$200 a day for help with bathing, dressing and toileting; $100-$180 a day for assisted living or adult family home; and $190-$250 a day for a nursing home.

Long-term care services are expensive because they're highly labor-intensive and needed over a long time. A person might need care just twice in four hours, but the caregiver must be paid for the entire four hours. The more care you need, the more expensive it is.

There's a silver lining in this bad news, and it's important. I said in an earlier column that the long-term care system is a very big ship in need of major reform. Those on Medicaid don't have the clout to make these changes — their care pays too poorly. But those who pay privately do: The industry wants their business. By learning to become wise consumers the private-pay market has the leverage to propel this ship in a new direction. That's my goal for writing this series.

Next week, I'll tell you how to assess a person's care needs. Then, later, I'll give you checklists of the right questions to ask.

Liz Taylor's column runs Mondays in the Northwest Life section. A specialist in aging and long-term care for 30 years, she consults with families and their elders. E-mail her at growingolder@ seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110.

You can see all of her columns at www.seattletimes.com/growingolder.