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Policy Must Address Challenges
Posed by Longevity
By Congressman Bill Cassidy, MD
PUBLISHED: January/February 2012
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A recent article in The Advocate featured a Baton Rouge woman. At first take, this woman sounds like a typical 53-year-old in the prime of her life. She is the stepmother of two teenage girls as well as a health care professional. What is not typical about this woman is that she was recently diagnosed with early onset Alzheimer’s disease.
Alzheimer’s disease is a dementia that progressively worsens—affecting memory, behavior, and thinking. More than 5 million people suffer from Alzheimer’s today. There are over 200,000 Americans younger than 65 struggling with Alzheimer’s disease. Currently, there are no known causes and no possibility of remission. While late onset Alzheimer’s is more common, cases like this Baton Rouge woman demonstrate this disease does not solely affect the elderly.
One factor in the increase in Alzheimer’s disease is that the number of Americans living into their eighties and nineties has grown dramatically. More than 10,000 baby boomers age into Medicare daily—this trend will continue for the next 19 years. One in eight Americans over 65 has Alzheimer’s disease and the percentage jumps to 43% in the 85 years and older population. As the U.S. baby boomers age, the number of people affected by Alzheimer’s is projected to triple.
Research into Alzheimer’s causes, symptoms, and risk factors has gained traction in the last 30 years, but it remains the sixth leading cause of death in the U.S.—the only cause of death in the top ten that lacks prevention, cure, or even the ability to slow the effects as it progresses. There is no foreseeable timeline of how the stages will develop in each person. For example, an Alzheimer’s patient may not need assistance with daily activities like using the restroom, eating or dressing for years after the diagnosis, but there is a chance an Alzheimer’s patient could require around the clock assistance in less than a year. In the final stage of the disease, an Alzheimer’s patient will lose the ability to communicate, fail to recognize family, and need constant care.
While the human toll is extraordinary, there are also associated economic costs. There are almost 15 million unpaid caregivers for Alzheimer’s and dementia patients in the U.S., who in 2010 absorbed an additional $7.9 billion in health care costs. In addition, those who take on this unpaid role deal with physical strain, competing demands, and the emotional toll of the disease. Specifically, one of the biggest hurdles facing individuals with younger-onset Alzheimer’s is the cost of care. Just as older Americans require long term care and financial assistance, so do those diagnosed at a younger age. Younger individuals may also face additional burdens because they lose out on prime earning years and may not automatically qualify for Medicare. In 2011, Americans will spend an estimated $183 billion on caring for individuals with Alzheimer’s disease.
The majority of the cost is covered by public programs like Medicare and Medicaid. Medicare costs are three times greater when a beneficiary is diagnosed with Alzheimer’s and other dementias while Medicaid costs are nine times greater. As baby boomers age into Medicare, the cost of long term care and acute care expenditures will continue to increase significantly. Long term care comprises nearly one-third of all Medicaid spending. John Hood writes in National Affairs that “from 1960 to 1990, the fastest growing category of health-care spending was long-term care.” So why is there such a lack in the private insurance market for long-term care—only 7 million people are insured? The reason for this is so involved that it requires a future article.
The U.S. needs a strong, viable solution to address the financial pressures entering the public health care programs. Of the general population, 4% will be admitted to a nursing home by age 80. This percentage jumps to 75% for people with Alzheimer’s disease. Currently, Medicaid encourages nursing homes, which is the most expensive type of long-term care. On average nursing home costs are double that of home care. Most seniors prefer to live in their homes as long as possible. Community care should be encouraged over institutional care.
While Congress discusses long term care policy, we must remember the individuals impacted by policy. Greater life expectancy is the result of medical advancements, but it is a double-edged sword as it brings with it new medical challenges for our country to meet. Until research can catch up with diseases such as Alzheimer’s, individuals must take an active role in health care and take on the task of planning for long term care needs.
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