St. Petersburg, Fla.
SEVERAL elderly couples stroll the banks of Mirror Lake here, enjoying the warmth of a welcome spring sun. Across the street, the shuffleboard courts are packed. And a bowling-ball game is in progress at the nearby lawn bowling club. Everywhere, it seems, the elderly are in motion.
But while these active oldsters don't seem to have a care in the world, appearances can be deceptive. Many have at least one major concern - that someday they might need long-term care.
``Everybody I know is thinking about it,'' insists a retired Pinellas County, Fla., employee who prefers not to give her name.
Every day an average of 1.5 million Americans, nearly 90 percent of them elderly, are being cared for in nursing homes. Many are receiving long-term assistance. Perhaps three times that number get similar aid at home.
Quality and cost vary widely, but nursing-home care is expensive. Experts project that by the year 2000 several times the current number of elderly will need financial assistance, and that Americans will be paying $129 billion a year to nursing homes by then.
Yet long-term care is a subject that many older Americans seem to want to discuss only in the abstract. When asked about their own concerns, they quickly change the subject. But they are more willing to talk about what they are doing to help others - which is, in fact, how many of the needs of the elderly are being met.
Here in St. Petersburg's cheery yellow-brick Sunshine Center for the elderly, Mrs. Herb Edmonds, a 76-year-old long-time volunteer, says, ``What I like to do is take care of the old people. I think they need a friend.''
For years America turned an unseeing eye to the problem of long-term care. Every year as many as a million people were spending themselves into poverty trying to pay nursing-home costs.
Untold hundreds of thousands of relatives and friends have been laboring, often without relief, to care for people in their homes.
The elderly and their families are no longer the only ones concerned about long-term care. Government officials recognize the problem. So do national political candidates and a growing number of ``sandwich'' generation Americans - middle-age people with children in college and with parents who require or may need expensive or time-consuming care.
``I believe that long-term care is going to be one of the major national issues in the next few years,'' says Alice Rivlin, an economist with the Brookings Institution. She recently completed a study and a book on the subject.
Developments are under way that should ultimately lead to better care, financial aid to those who need it, and help for those who labor unrecognized outside their immediate families.
For one thing, Americans of all ages now realize that neither Uncle Sam's medicare program nor most general-purpose health-insurance plans cover long-term care. That knowledge is a necessary first step to improvement.
Most experts say a combination of private insurance and government programs should provide most of the funding, but they disagree widely on the blend.
Virtually every expert says long-term care is a problem that can be insured against by spreading the risk - by encouraging many people to purchase insurance that only a small percentage will ever need.
Small but quickly growing numbers are buying specific insurance to cover long-term care. About 70 insurance companies now offer improved, though far from perfect, plans.
``Over half a million people are covered at this time,'' says Bruce Boyd, chairman of the long-term-care task force of the Health Insurance Association of America. That's 2 times more than just three years ago.
Congress has begun looking at the issue. Most experts say 1988 will be a year of exploration, with actual changes in federal law likely in the next administration.
In a few weeks the US House of Representatives is scheduled to vote on a proposal by Reps. Claude Pepper (D) of Florida and Edward Roybal (D) of California that would provide financial help to people being cared for at home.
A number of very different proposals are being introduced into Congress that would craft government's response to helping Americans with the cost. Several hearings will explore the issue this year.
Meanwhile, two Florida metropolitan areas, Orlando and Fort Myers, are slowly expanding a telephone hot line that links a broad array of previously unconnected services, from health care to housework, which can help senior citizens stay at home.
The American Association of Retired Persons is working on plans for a nationwide hot line that will offer people information and referrals on health services available in their communities. For the past year the 28 million-member AARP has made long-term care one of its main focuses. Its campaign was instrumental in bringing the issue into the national spotlight this year.
More need for long-term care
Relatively few people in their 60s require nursing-home care. But 3 in 10 Americans over 85 - the fastest-growing age group - now spend at least part of every year in nursing homes.
Demographers say the number of Americans over 65, now nearly 30 million, will double in the next 40 years. More important, the number of Americans over 85 will keep growing at the fastest rate: 1 percent is now over 85; by 2030 nearly 3 percent (8.6 million people) are expected to be.
``We will have more people needing long-term care'' than America can now aid, says Dr. William Roper, administrator of the Health Care Finance Administration of the United States Department of Health and Human Services. His agency handles medicare and medicaid.
Nationally, individual Americans pay nearly half the cost of nursing-home care from their own pockets. Medicaid, the program that is supposed to help the poor with medical expenses, pays a little more than 40 percent. Private health insurance and medicare - the federal program supposed to provide dollars for the elderly's health care - together pay less than 3 percent. At-home care costs vary from case to case but are usually less.
In recent years US health-care costs have been rising faster than the inflation rate: Now at 12 percent of the gross national product, they are expected to reach 15 percent by the turn of the century. Given today's massive federal deficit problems, can Uncle Sam afford to pay any additional health-care costs, even for a purpose as worthy as this? Experts disagree.
Many spouses left destitute
At present, couples must virtually spend themselves into poverty before medicaid will help pay for long-term care. No one wants to leave a spouse destitute. But this happens every year to hundreds of thousands of Americans in nursing homes, where the average annual cost is $22,000. Congressman Pepper says that ``a million Americans become pauperized'' this way annually. Even middle-class America, he adds, is ``not able to meet the [financial] demand'' of long-term nursing-home care.
And nursing homes are not even half the story. ``Seventy-five percent'' of all long-term care takes place in the home, says Thomas Burke, chief of staff of the Department of Health and Human Services.
Nearly all of that is provided by family members or friends. Dr. Rivlin says the evidence shows ``that the family system in the United States has responded'' to the long-term care needs of relatives ``quite remarkably.'' She says the overall ``burden on the family has increased enormously'' in recent years, as middle-age couples have to raise children, work outside the home, scrape up college-tuition payments, and care for older relatives, often all at the same time.
First of five articles. Next: Who should pay for care?