Harris Proposes that Medicar cover Long-Term Care at Home

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This would require massive immigration to actually staff, no matter how much money was available, and at the same time those immigrants are being sought after by other countries with declining demographics.

well, we have that already ... massive immigration. too bad they are all unskilled.

Who do you think work at the low paying jobs, including elderly and nursing care.

Exactly. Elder care/home health aides, landscaping, produce field work...these jobs are ones most Americans will not do, and yet they are VITAL.

When my (late) Dad needed help at home, it's nearly impossible to find/keep, because there aren't enough immigrants even. There are elderly people who end up in MUCH more expensive nursing homes, because of not being able to find home help.

We were able to keep Dad at home until the last 3 weeks, mainly because of my Mom caring for him, me helping, and what help we were able to find. Without the help, he probably would have spent at least a year in a nursing home, which is far more expensive than the occasional help.

There are a lot of immigrants who do not work in elderly care. Should the US have some type of rule that people can only immigrate here if they are willing to work at least X number of years in elder care?

No of course not. You can do the job. Why don’t we force you?

If I wanted to immigrate to another country and that was a requirement, I could choose to do it or choose not to immigrate.

But my situation is irrelevant. PP said that we need immigrants to do this work, and now you are saying that immigrants should not do the work.
So which is it?

Why should you force immigrants to work in a specific area? All that we should require is that they hold a job once they arrive and the vast majority do (despite what you will read online SM from MAGA enthusiasts). Most work hard, and at the same time are working to educate themselves/get trained for a career path they want to pursue. They contribute to the economy/pay into SS, medicare, etc. before they are eligible for any of it.

[Anonymous]

Anonymous wrote:Vote buying--not sustainable.

It currently costs $30 per hour for home care.

It costs $262,800 for 24 hour care for a senior in home for 1 adult under care.

This is not fiscally supportable.

That is what nursing homes are for. You can get that care for $10-12K/month. Yes, not the same as 1-1 care, but fact is most cannot afford that. So most do nursing homes, with local family visiting as much as possible

[Anonymous]

Anonymous wrote:

Anonymous wrote:Vote buying--not sustainable.

It currently costs $30 per hour for home care.

It costs $262,800 for 24 hour care for a senior in home for 1 adult under care.

This is not fiscally supportable.

That is what nursing homes are for. You can get that care for $10-12K/month. Yes, not the same as 1-1 care, but fact is most cannot afford that. So most do nursing homes, with local family visiting as much as possible

My understanding is that this proposal would cover not just seniors but also family members with disabilities requiring care. This would allow someone at cerebal palsy or MS to remain at home, receive care during the day, then be with family at night.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Vote buying--not sustainable.

It currently costs $30 per hour for home care.

It costs $262,800 for 24 hour care for a senior in home for 1 adult under care.

This is not fiscally supportable.

That is what nursing homes are for. You can get that care for $10-12K/month. Yes, not the same as 1-1 care, but fact is most cannot afford that. So most do nursing homes, with local family visiting as much as possible

My understanding is that this proposal would cover not just seniors but also family members with disabilities requiring care. This would allow someone at cerebal palsy or MS to remain at home, receive care during the day, then be with family at night.

Shouldn't that already be covered under medicaid (assuming you are talking about people that are under the age of 65?)

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This would require massive immigration to actually staff, no matter how much money was available, and at the same time those immigrants are being sought after by other countries with declining demographics.

well, we have that already ... massive immigration. too bad they are all unskilled.

Who do you think work at the low paying jobs, including elderly and nursing care.

Exactly. Elder care/home health aides, landscaping, produce field work...these jobs are ones most Americans will not do, and yet they are VITAL.

When my (late) Dad needed help at home, it's nearly impossible to find/keep, because there aren't enough immigrants even. There are elderly people who end up in MUCH more expensive nursing homes, because of not being able to find home help.

We were able to keep Dad at home until the last 3 weeks, mainly because of my Mom caring for him, me helping, and what help we were able to find. Without the help, he probably would have spent at least a year in a nursing home, which is far more expensive than the occasional help.

There are a lot of immigrants who do not work in elderly care. Should the US have some type of rule that people can only immigrate here if they are willing to work at least X number of years in elder care?

I'm the PP you quoted. I never said that immigrants only work in elderly care. Having experience finding home health for my own parent, I found that most home health workers are immigrants (and they work hard in a difficult job).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This would require massive immigration to actually staff, no matter how much money was available, and at the same time those immigrants are being sought after by other countries with declining demographics.

well, we have that already ... massive immigration. too bad they are all unskilled.

Who do you think work at the low paying jobs, including elderly and nursing care.

Exactly. Elder care/home health aides, landscaping, produce field work...these jobs are ones most Americans will not do, and yet they are VITAL.

When my (late) Dad needed help at home, it's nearly impossible to find/keep, because there aren't enough immigrants even. There are elderly people who end up in MUCH more expensive nursing homes, because of not being able to find home help.

We were able to keep Dad at home until the last 3 weeks, mainly because of my Mom caring for him, me helping, and what help we were able to find. Without the help, he probably would have spent at least a year in a nursing home, which is far more expensive than the occasional help.

There are a lot of immigrants who do not work in elderly care. Should the US have some type of rule that people can only immigrate here if they are willing to work at least X number of years in elder care?

No of course not. You can do the job. Why don’t we force you?

If I wanted to immigrate to another country and that was a requirement, I could choose to do it or choose not to immigrate.

But my situation is irrelevant. PP said that we need immigrants to do this work, and now you are saying that immigrants should not do the work.
So which is it?

The only person saying immigrants should NOT do the work is you.

Most of these jobs are filled by immigrants. Many also pursue a nursing degree to increase their wages and employment prospects. When they leave, the jobs are often filled by a new round of immigrants.

Right. When my great grandfather came here, he worked in a factory. He eventually opened a business. His kids went to college. It's how people gain a foothold here.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Vote buying--not sustainable.

It currently costs $30 per hour for home care.

It costs $262,800 for 24 hour care for a senior in home for 1 adult under care.

This is not fiscally supportable.

That is what nursing homes are for. You can get that care for $10-12K/month. Yes, not the same as 1-1 care, but fact is most cannot afford that. So most do nursing homes, with local family visiting as much as possible

My understanding is that this proposal would cover not just seniors but also family members with disabilities requiring care. This would allow someone at cerebal palsy or MS to remain at home, receive care during the day, then be with family at night.

Shouldn't that already be covered under medicaid (assuming you are talking about people that are under the age of 65?)

In-home care is not covered and families bankrupt themselves.

[Anonymous]

Immigrants working “x” amount of time in elder care, could be a path to citizenship.

[Anonymous]

Anonymous wrote:

Anonymous wrote:We have a waiver program for the poorest but the income care is limited to 10 hrs a week. Would be lovely to see Medicare cover more!

So let's get some things straight.

Medicare is for elderly.

Medicaid is for the poor and has asset qualifications.

Both programs are currently going insolvent in the next decade - even without this program. So no people did pay in all that much over the years.

Even if this passes good luck finding reputable people to be in house aids.

Impossible. Impossible without massive immigration, anyway (as a pp pointed out).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:We have a waiver program for the poorest but the income care is limited to 10 hrs a week. Would be lovely to see Medicare cover more!

So let's get some things straight.

Medicare is for elderly.

Medicaid is for the poor and has asset qualifications.

Both programs are currently going insolvent in the next decade - even without this program. So no people did pay in all that much over the years.

Even if this passes good luck finding reputable people to be in house aids.

Impossible. Impossible without massive immigration, anyway (as a pp pointed out).

But even with mass immigration, there is no guarantee that the immigrants will choose to become caregivers for elderly.
I have four sisters-in-law who are immigrants and not a single one of them is a caregiver for elderly people.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:We have a waiver program for the poorest but the income care is limited to 10 hrs a week. Would be lovely to see Medicare cover more!

So let's get some things straight.

Medicare is for elderly.

Medicaid is for the poor and has asset qualifications.

Both programs are currently going insolvent in the next decade - even without this program. So no people did pay in all that much over the years.

Even if this passes good luck finding reputable people to be in house aids.

Impossible. Impossible without massive immigration, anyway (as a pp pointed out).

But even with mass immigration, there is no guarantee that the immigrants will choose to become caregivers for elderly.
I have four sisters-in-law who are immigrants and not a single one of them is a caregiver for elderly people.

So...do they have college degrees? Most immigrants who go into these positions do not have college degrees, sometimes barely made it through secondary school due to war, poverty, etc. Simply because four of your SiLs did not go into caregiving doesn't mean that the profession is not predominantly staffed by it. There is a strong demand for it and that is often why immigrants "choose" it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Vote buying--not sustainable.

It currently costs $30 per hour for home care.

It costs $262,800 for 24 hour care for a senior in home for 1 adult under care.

This is not fiscally supportable.

That is what nursing homes are for. You can get that care for $10-12K/month. Yes, not the same as 1-1 care, but fact is most cannot afford that. So most do nursing homes, with local family visiting as much as possible

Think outside the DCUM bubble. Most seniors can’t afford that.

This is not going to be a simple piece of legislation. Obviously there would need to be some serious hammering out. I do think it’s solvable and we can start with taxing billionaires. Healthcare in the US is a for profit industry. Estimating the cost of programs based on current care costs probably doesn’t yield a good estimate. Look at the salaries and bonuses paid to top Insurance execs and Eldercare company execs. They are enormous. Higher tax on UHNW and a system outside of the for profit industry are good places to start the framework.

[Anonymous]

It's not happening. Where would you like her to cut spending? Early intervention? Programs for special needs youth and adults? Food stamps? Maybe the military so Iran can take us over?

Anonymous wrote:

Anonymous wrote:No one would be happier than me if this aid came about.

However

We have such a large number of aging people about to need this care and it is SO expensive.

I don't understand how we could pay for it, as a nation.

Increase taxes
Cut spending in other areas.

[Anonymous]

Anonymous wrote:Considering full time care is 250K/ year we'd need taxes from 10 average Americans working to support 1 person with live in care.

There would definitely be a cap on the amount of reimbursement. (population budgeting... not sure what they mean by that, but for sure it means a limit on hours of care) And the way it is being envisioned, there would be an asset/means component. People with more income and assets would have a large co-pay...


https://www.brookings.edu/articles/a-home-care-benefit-for-medicare

Eligibility for the program would be restricted to people who independent clinical reviewers determined were unable to perform two activities of daily living (e.g., bathing, toileting, or eating). That’s the standard that many State Medicaid programs already use, and it could be assessed annually during the initial implementation period to further develop and monitor the uniformity of functional assessments over time.

Second, the program would include cost-sharing that varied according to people’s means. Medicare beneficiaries with high income and assets would receive modest assistance from the program to defray a portion of the costs of home care; those with fewer assets and less income would pay much less.

Third, beneficiary contributions to the costs of their care would depend on both their current income and their accumulated assets, but through cost-sharing rather than a strict cutoff. For example, at the cost listed above, we could allow all qualifying Medicare beneficiaries to fully retain income up to 150% of the poverty line ($22,600 in 2024) and assets up to $30,000; beyond that limit, individuals would still qualify but would pay cost-sharing out of their resources to defray taxpayer costs.

Fourth, only care provided by formal caregivers associated with home care agencies would be covered. Hours of support would be based on need, but provider agencies would be subject to a population-based hours of service budget. The combination of resource-based copayments with population-level budgeting will ensure that the costs of this program will not explode.

Finally, Federal Medicaid savings from shifting home care benefits from Medicaid to Medicare would be used to defray the costs of the program.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Considering full time care is 250K/ year we'd need taxes from 10 average Americans working to support 1 person with live in care.

The good news is, this person's kids would get to inherit the house! While the 10 average Americans can't afford one.

Of course being elderly and needing care is no guarantee that you’ll own a house, or that you’ll have kids.
And if you have kids, there’s a chance that one of them is jeopardizing their own chances of a comfortable retirement— and of ever owning a house — because their career goals got derailed because they were providing eldercare. So, yeah, it IS good news.

Under this plan, they are not. They are just reaping the benefits from taxes of 10 average Americans.

Not even close to that, no. Any plan that gets passed will definitely be means tested - not as much as Medicaid, for sure. But there will be less aid for aides, the more money or assets you have.