Omdahl: Long Term Care Funding in Crisis
Compared to the number of elderly in other states, North Dakota is ranked as an old state – and growing older.
In 2015, we had 107,900 folks 65 years of age and over, or 17 percent of the population, compared to 14.5 percent nationally. In 2030, we will have 152,300, or 25 per cent, compared to 19 percent nationally.
An aging population creates a plethora of problems, most of them medical, as society struggles to keep every person alive as long as possible, sometimes even against personal wishes.
Because North Dakota will have a disproportionate share of elderly, provision of adequate health care will be more challenging here than in other states.
Not only do we have the numbers, but the distribution of elderly leans to the rural more than the urban while medical facilities and services lean in the opposite direction.
For 2016, the average cost of nursing home care is set at $258 daily or $94,170 annually. Even without arthritis, that price tag alone is enough to darken the skies during “golden” years.
Most people die without institutionalized long term care. This suits North Dakota, where a wide streak of individualism and independence has been with us since the first days of settlement.
Going into the last years without enough gold is a gamble, however, and nothing is as demeaning as “going on welfare” after years of complaining about n’er-do-wells on food stamps.
To rescue people unable to pay medical bills, the taxpayers support Medicaid-a program to pay for medical care for people who do not have insurance or money.
While Medcaid is used most widely for the routine medical needs of the poor, it is also used to pay the $94,000 annual costs for long term care for indigents.
With a dramatic increase predicted in the number of elderly, we should expect an increase in the number of Medicaid-eligible long term care users. We’re talking about big money.
There are several categories of people who end up in nursing homes with Medicaid picking up the tab.
First, there are folks who never had the educational opportunities or personal capabilities to become self-sufficient. In some cases, they may have lived in a subculture in which dependency is the norm.
Second, there are working folks who are barely getting by, living from one paycheck to the next. They work in establishments that do not pay wages high enough to buy long term care insurance or save for nursing home care.
Third, there are the able-bodied citizens who spend a lavish life on the high road, without care about future obligations or responsibilities. They are just improvident.
Fourth, there are the wealthy that make themselves poor in order to become eligible for Medicaid. This practice is politely called “asset preservation”.
Of course, asset preservation requires long term planning because clients must make themselves poor at least five years before getting into the Medicaid bed at taxpayer expense.
Asset preservation may not be an ethical question in the secular world where “if it’s legal, it’s ethical.”
However, Christian (that’s supposed to be most of us) ethics includes rendering unto Caesar what is Caesar’s and it seems that asset preservation is stealing from Caesar.
The ethical issue gets more complicated when we contribute to good Christian causes while planning to have taxpayers pay for our nursing home care. The taxpayers end up being the ultimate contributors.
With the state facing the burgeoning medical costs of an aging population, people in their earning years will be required to accept more responsibility for their long term needs. This will require some North Dakota individualism and independence.
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