I’m really wildly optimistic and think the real problem with private long-term care insurance is that medical science will soon eliminate the conditions that lead to many of the claims.

Issuer executives will suddenly have to spend their days defending the windfall profits they’re earning just because Alzheimer’s disease and Parkinson’s disease went away.

But, assuming that the claim drivers do stay roughly the same, and the number of people who need long-term care services 20 or 30 years from now is much higher than the number who need such services today, I think one problem society will face is all of the utopian ideas people have been spreading about “patient-centered care” and the glories of home care.

If we’re really facing a silver tsunami, with no significat amount of prefunding the handle the flood, there won’t be any wonderful patient-centered anything. There will be valiant efforts to keep people in permanent buildings, as opposed to in boxes on sidewalks. Ideally, caregivers will do their best not to be intentionally cruel.

Any people who are counting on much more than that had better have loving, dutiful children with nursing experience, great wealth, or plenty of private long-term care insurance.

People who part of a tsunami can’t really expect the people on the beach to handle them with silver plate and bone china.

I think another big problem is lack of honesty about the true cost of home care.                

Home care probably looks cheaper because the people who can stay reasonably safely home alone tend to be healthier than the people who need to be in a nursing home, and because people can cheat a lot more easily on home care.

Even a bad nursing home has to make some effort to understand and comply with federal and state facility standards, and to get through inspections. It has make sure most of its employees are in the United States legally, or look as if they are.

Meanwhile, many families that use home care hire workers in the country without proper documentation and avoid any worries about meeting building safety codes or other safety codes.

Realistically, well-designed home care programs that are based in people’s real homes will be much nicer than nursing homes, but it’s hard to see how true home care can be cheaper.

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If assisted living communities can get people to move into separate, home-like apartments, to make delivering care “at home” much more efficient, then that might help home care costs compete with nursing home costs.

But one way to bring some realism to the discussions is to acknowledge that putting the people who need care close together may be the only practical way to provide enough long-term care services at an acceptable price.

Allison Bell is a senior editor at LifeHealthPro.com.

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