When the Congressional Budget Office released their “Health Budget Options” report last week, I eagerly scanned through the tome for recognition and support for caregivers—like myself—of people with disabilities or chronic health conditions. We’re mentioned in a parenthetical in Chapter 10 on Long Term Care:

“(Much long-term care is provided personally by the family and friends of elderly and disabled individuals.)”

Earlier in the chapter, CBO points out that patient/family out-of-pocket spending accounted for 20% of the total long term care spending. While one-fifth of spending is a lot, I think it probably underestimates the full value of direct care provided by the family, purchases of needed non-prescription and non-reimbursed medical equipment and supplies, and lost income by the caregiving family members.

CBO does make some oblique references to the magnitude of unaccounted-for care in its discussion of the pros and cons of adding home-based care incentives to Medicaid—the dreaded “out of the woodwork” factor—the number of people they cannot count who might come forward for services and wreck federal-state budgets.

Over the last few years, despite a restrictive prospective payment system, home health services for seniors eligible for Medicare has increased so rapidly that CBO and MedPAC both recommended reigning in spending by reducing rate updates and—to my horror—a suggested co-payment of 10%. CBO says:

“An argument in favor of this option [co-payment] is that it would directly offset a portion of Medicare’s home health outlays and encourage beneficiaries to use those services in a cost-conscious manner.”

I wonder if these analysts have ever used home health services for their needy family members. Caregiving for people with chronic health conditions is a round-the-clock commitment. The home health benefit under Medicare provides a measly couple of hours per day, a few days per week. We are already contributing way more than 10% to the home care of the beneficiary, and I can assure CBO that we do so in an extremely “cost-conscious manner” since we pay at least 20% of long term care services out-of-pocket—didn’t the analysts read ahead to Chapter 10?

When it comes out of your own pocket, you make every penny count, and you make the best use of services—like the home health nurse, aides, therapists—to maintain the independence and dignity of the family member you’re caring for, and to give the caregiver much needed support, information, and relief.

There’s some teeth-gnashing in the report about the low enrollment rate in long term care insurance policies. One of the reasons is the high cost of the premiums in relation to the daily benefits. If you have a chronic condition, you’re unlikely to qualify, or the premium is beyond reach. If you’re a caregiver, chances are you don’t have a lot of leeway in your budget to purchase a policy. I’m not convinced that the alternatives offered in this report will help much.

All-in-all, I was disappointed to see that the options listed in the appendix were organized by stakeholders but did not include a cross-reference by patient or caregiver.

The report is discussed on the CBO director’s blog at: http://cboblog.cbo.gov/?p=193.

Related posts:

1. Reactions to the Congressional Budget Office Reports
2. Blog Roundup: President Obama's budget plan for health care reform
3. Medical Home is a Doc’s Office Not Your Living Room
4. Transitional Care: A Way to Save $18 Billion – and Improve Health Outcomes
5. Sweet home—medical or health?

This entry was posted on Tuesday, December 23rd, 2008 at 3:20 pm and is filed under Caregiving, Consumer Health Care. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.