Discriminated Against for Having the “Wrong Type of Illness”

Doctor and Patient

Long-term care services, whether provided in institutions or in the community, are essential to the well-being of many elderly and non-elderly people with limitations in performing daily activities. In the United States, in particular, long-term care is disastrously expensive. And, when it comes to benefits, some people are discriminated against simply because they have the “wrong type of illness.”

In part 1 of this special report, we looked at long-term care in the U.S. and other countries. We explored the median net worth of the citizens of eight countries, and how much long-term care that would cover if someone were to pay for it out-of-pocket. We examined how long-term care is paid for and similar challenges that are faced by most countries, when it comes to providing citizens with assistance to pay for it. We also looked at how the Medicaid program is our country’s largest health and long-term care insurer, covering one in six Americans, including two-thirds of nursing home residents and one in five persons under 65 with chronic disabilities, and the complexity involved in applying for Medicaid benefits.

In part 2, we will now cover how America and a few other countries effectively discriminate against people with the wrong type of illness.

Medicare in the United States

In the U.S., Medicare is the public health insurance system for seniors over 65 and disabled adults, and it only pays for medical care delivered by doctors and hospitals and, in certain cases, short-term rehabilitation which might take place in a nursing home. For decades, Medicare has effectively discriminated against older adults with psychological conditions, such as depression and anxiety, because these conditions have received unequal treatment under Medicare. Medicare has paid a smaller share of the bill for therapy from psychiatrists, psychologists or clinical social workers than it did for medical services and has imposed strict lifetime limits on psychiatric hospital stays.

In 2008, Medicare covered 50% of the cost of psychological treatment, while in 2013, it covered 65%. In 2014, Medicare began paying 80% of its approved amount for certain outpatient mental health services. Payment kicks in once someone exhausts an annual deductible of $147 per year.

Medicare will pay for the services of medical doctors (such as psychiatrists) who do not take Medicare (non-participating providers), but these doctors can charge you up to 15% above Medicare’s approved amount. Some states have stricter limits on how much doctors can charge. Find out more about Medicare’s Mental Health benefits on the Medicare.gov website.

Since its inception, Medicare has also discriminated against many older adults in that Medicare does not pay for the type of care that is needed by people suffering with certain diseases; specifically, Medicare (and, for that matter, private health insurance) does not pay for the care that is needed by people suffering from chronic illnesses such as Alzheimer’s disease or other types of dementia, or other brain diseases that cause a diminished ability to function without assistance from others. When a family has a loved one with one of these “wrong types of diseases,” that family must become officially “impoverished” under federal and state Medicaid rules in order to gain access to the basic care that is needed as a direct result of the individual’s illness.

The chart below shows dementia care and coverage in other countries that don’t seem to discriminate based on type of illness (from Alzheimer-europe.org and other sources):

Country

Dementia Care and Coverage
Italy
Care in Italy for those with dementia can consist of home care (community care); integrated home care services(a combination of integrated and coordinated health and social activities which seek to keep an elderly person at home as long as possible); day centers (semi-residential structures); or nursing homes.

Italian citizens must purchase a ticket in order to have access to services within the National Health Service. People who are over 65 years old and those suffering from an officially recognized chronic and disabling disease do not have to pay.

Japan
Japan’s dementia strategy, which was started in 2012 and updated in 2014, involves the health ministry and 11 other ministries and agencies. The strategy funds research, prioritizes early detection, trains front-line health workers, provides support for caregivers, and creates “dementia-friendly” communities.

The most important change Japan has made to improve dementia care, however, came in 2000, when the government introduced mandatory long-term care insurance.

A primary goal was to help seniors live more independently and reduce the burden on relatives — particularly women, who are often the caregivers. So unlike long-term care insurance in countries like Germany, which offer cash, Japan’s system offers services — and consumer choice.

The scheme works like this: at age 40, every Japanese resident pays a monthly insurance premium. When they turn 65 — or get sick with an aging-related disease — they become eligible for a range of services: everything from dementia daycare to lunch delivery and bathing assistance. Depending on income, users also pay a 10% or 20% service fee — a measure that discourages overuse.

United Kingdom (Scotland, in particular)
The Community Care and Health (Scotland) Act 2002 ensured that people with conditions, such as dementia, were granted:
•free nursing and personal care for people over the age of 65;
•increased access to direct payments for home care services;
•the right to be assessed by informal caregivers, and that they are made aware of that right;
•that the contribution and views of caregivers, as well as the person they care for, are taken into account by local authorities before deciding which services to provide.

This is not dependent on financial status, capital assets, marital status,or the amount of care provided by an unpaid caregiver.

It is a tremendous shame that our country’s social policies essentially discriminate against those who get the “wrong types” of illnesses, such as Alzheimer’s and other forms of dementia. It is extremely unfair for Medicare to provide full coverage for most diseases but force those with the “wrong type” of disease to go broke financially in order to gain access to the basic care needed – care which our society calls “long-term care” instead of “health care.”  It should be no surprise to anyone that most knowledgeable families seek legal methods to preserve the efforts of a lifetime in order to protect themselves from our country’s unfair social policy.

If you have a loved one who is nearing the need for long-term care or already receiving long-term care, please contact us as soon as to schedule your appointment for our no-cost initial consultation:

Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797

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