Why can’t The Washington Post ever get it right when it comes to long-term care. Its latest self-embarrassment came with a piece it ran today comparing elder care in the U.S. with similar assistance in France and the U.K.
According to the author, a psychologist named Sara Mansfield Taber, elderly women in England and France receive far better care than the writer’s mother did in the U.S. Unfortunately, she hopelessly confuses health care with long-term care and paints a picture of high-quality personal supports in Europe that I only wish really existed.
In truth, the system of long-term care in England very closely resembles the deeply flawed welfare-like arrangement we have in the U.S. through Medicaid. While nursing care is provided as part of the National Health System, government-supported personal assistance such as home health aides provide is only available for those with few assets and very low incomes.
This is troublingly similar to the U.S, and has been the subject of severe criticism in the U.K. for decades. One scathing 2006 report by the Joseph Rowntree Foundation concluded “the public finds the present system incomprehensible and considers its outcomes unjust.”
Because benefits vary so widely by locale in the U.K. the system is often disparagingly referred to as the “postcode lottery.” Indeed, the current labour government of Gordon Brown is proposing major reforms to address some of these perceived inequities.
In France, the author’s other model, government long-term care benefits are also based largely on income. Unlike the U.K. and the U.S., where those with more than $2,000 in financial assets and less than $700- a-month in income usually receive no Medicaid benefits, in France everyone who suffers from severe enough disability gets some assistance. However, they face some fairly tough limits. First, to be eligible, a person must be significantly more disabled than in the U.S. Second, benefits are sharply reduced for those not in poverty. The average monthly benefit for someone receiving home care in France is only about $600. And while someone who is very poor gets about $1,400 per month, a person with income of about $4,000-a-month would get less than $300 for home care.
The French middle class has found the public long-term care benefit so insubstantial that about 25 percent of those 65 or older feel the need to purchase private long-term care insurance to supplement this government assistance. Fewer than half that many have bought this insurance in the U.S.
Don’t get me wrong, the U.S. system for providing long-term care is shameful. And Congress is finally taking some steps to both expand home care benefits under Medicaid and create a national long-term care insurance program to help middle-class people begin to prepare for their frail old age. But despite what The Post would have you believe, the systems in the U.K., and France are hardly panaceas.
When it comes to long-term care, we all have work to do. Especially The Post, which provided wildly inaccurate commentary on alleged “death panels” last summer, and has been unable to write about long-term care reform in any serious way during the current debate over health care.