Planning for the long term

Amid growing concerns about rising costs for older citizens, Pennsylvania joined a federally backed effort this year to encourage personal planning for long-term care.

A glossy brochure on the subject, titled "Own Your Future" and featuring a photo of a smiling Gov. Rendell, landed during March in the mailboxes of 1.7 million Pennsylvania residents aged 45 to 65.

The mailing urges middle- and senior-aged people to write, call, or visit a Web site to order a long-term-care "planning kit" from the U.S. Department of Health and Human Services.

The kit, including a CD, offers a road map for designing legal and financial plans, investigating long-term-care insurance and community resources, talking with family members about future care needs, and making small changes to a home to make it safe for an elderly resident. New Jersey offers similar information. 

The federal government put $440,000 toward the 1.7 million brochures mailed in Pennsylvania, with the state kicking in $1 million to promote the campaign on radio and TV.

Within its Medicaid program alone, Pennsylvania paid $297 million for home care for seniors and nearly $3 billion in per-diem payments to nursing homes for its 2006-07 budget year.

The brochure's arrival miffed some friends of Pennsylvania Secretary of Aging Nora Dowd Eisenhower. "Does this mean I'm getting old?" they asked her, Dowd Eisenhower, 54, recalled in an interview.

About 9.6 percent of recipients have ordered the kit since the Pennsylvania mailing, Dowd Eisenhower said. New Jersey was one of the first states to take part in the campaign in mid-2005. This year, Pennsylvania and Ohio became the latest of 18 participating states.

"Pennsylvania is an old state," Dowd Eisenhower said. The commonwealth has the third-highest percentage of citizens over age 65, after Florida and West Virginia. By 2020, experts say, about one in four Pennsylvanians will be 60 or older.

The federal government estimates roughly seven of 10 Americans over age 65 will need some form of long-term care - such as in-home assistance or nursing home care - at some point in their lives.

Meanwhile, the costs of long-term care are rising faster than inflation. According to insurer Genworth Financial Inc., which does an annual survey on nursing home costs, the price of nursing home care in Pennsylvania, excluding Philadelphia, has increased 25 percent since 2004. In Philadelphia, the cost has increased 15 percent over the last five years, and it was up 17 percent nationwide. One year in a private room in a nursing home costs an average $99,840 in Philadelphia and $80,704 elsewhere in the state.

Genworth Financial notes that the national average cost of a year in a private room in a nursing home, $76,460, is more than one and a half times the average U.S. household income of $48,201.

"Most people think that nursing home care will be picked up as a cost by Medicare," Dowd Eisenhower said. "At the clip of $60,000 annually or more, it's a big mistake." Medicare covers nursing home care only in limited circumstances or for limited lengths of time. Medicaid programs can pay for long-term-care services, but only for those with limited incomes and assets.

Even home-based care has its costs. The federal government estimates a home health aide visiting a home three times a week would cost almost $16,000 a year.

Long-term-care insurance is an expensive and complex option, with premiums varying according to a person's age and health at the time of purchase and options selected. The Pennsylvania Insurance Department said the premium on a policy for a 65-year-old could range anywhere between $1,500 and $6,000 per year, depending on features of the plan.

"All of this has really led us to be more focused on how we can help people in Pennsylvania prepare for what's coming," Dowd Eisenhower said.

The Own Your Future campaign acknowledges the emotional difficulties people may have when contemplating their potential needs for long-term care, or when talking about it with family members. But, "overall, this taking ownership of your future and planning ahead, we believe, increases the choices of where and how you receive long-term-care services," said Tom Kickham, an official with the Department of Human Services' Centers for Medicare and Medicaid Services.

Dowd Eisenhower said another Own Your Future mailing in Pennsylvania was planned for later this month. Anyone can request the kit by calling toll-free 1-866-752-6582 or going online.