Seniors, Long-Term Care, and Medicare for All
People are living longer and, in the process, need more help.

A while back I was talking with an accountant who said that actuaries were suggesting that people should plan for their retirement assuming that they would live to 105. Most people can’t plan past the next month—if you’re a waitress in the local diner, you may make less than the minimum wage. Your plan for retirement is to work until you drop.

This has implications for our Medicare for All program—we need to think about what this program should look like for an aging US population. For example, a friend of mine was diagnosed with early-onset Alzheimer’s when she was in her 50s. She died 20 years later, having spent a good part of those 20 years in a nursing home. Then there was my mother-in-law—after my father-in-law died she couldn’t live on her own, but not needing a high level of medical care, she was in an assisted living home for about 10 years. Another friend’s husband had another form of dementia; she retired to take care of him at home.

These stories are not unusual; more and more people are living longer and, in the process, need more help and often those living longer and those providing the help are women. What do the data tell us? has a lot of information; they note that ⅔ of the people requiring some form of long-term care are older and that the definition of care ranges from managing money and taking medication to help with dressing and eating.

Some disabilities and chronic conditions, such as diabetes, result in a need for care whether one is 47 or 97. Today 80% of at-home care is provided by an unpaid caregiver. Two thirds of the caregivers are women. If someone requires paid care, the costs can be enormous—the national average for a private room in a nursing home is almost $7,700 per month; for a one-bedroom unit in an assisted living facility, the average is over $3,600 per month. Even eight hours for one day in an adult day care facility can cost over $500. There is the alternative of a home health aide—someone who will come to your home to help—that runs about $20 per hour. That’s about $3,200 per month—not much for the full-time home health aide, but a lot of money for an individual to pay out.

Where is this money coming from? Mostly, it’s not coming from Medicare. Medicaid, however, does pay for much of long-term care, but to get Medicaid there are eligibility requirements, including income requirements. All too often surviving spouses (typically women) are left destitute because all their resources are used for long-term care for their spouse. This is true even for middle-income families.

The good news is that Bernie Sanders’ Medicare for All bill (S. 1804) incorporates both Medicare and Medicaid coverage for long-term care. It covers long-term care and palliative care, such as hospice. When this bill passes, it will be a crucial step in ensuring that no one has to choose between medications and food. Families will not be left impoverished with long-term care having eaten up their savings. As it says at Bernie Sanders’ Medicare for All site, “Seniors and people with serious or chronic illnesses could afford the medications necessary to keep them healthy without worry of financial ruin. Millions of people will no longer have to choose between health care and other necessities like food, heat, and shelter, and will have access to services that may have been out of reach, like dental care or long-term care.”

What does this mean for our Medicare for All campaign? When the Tea Party first came out swinging, a sign at one of their rallies read, ‘Keep the government off my Medicare.’ We need to encourage seniors to speak out on the benefits of Medicare. We also need to acknowledge that it’s important to keep the current government—President Trump, Senator McConnell, Representative Ryan—out of Medicare and Medicaid. We need to further expand the benefits both to those already receiving Medicare and to those who are not insured.

We can seek out coalition partners and advocates in senior organizations and centers. We can organize programs at local libraries and community centers to rally seniors around Medicare for All. While seniors have been among the groups most supportive of the current right-wing tendencies, Medicare for All is an issue that can begin to move this group in our direction.

Organizing such as this was undertaken by some of our Colorado chapters. In February, Denver DSA held a Medicaid Sign Up event at a local library. They targeted uninsured areas of Denver in their leafleting, using census data from the state of Colorado to map out zones. The library was in an area with a high concentration of uninsured folks. After mapping out the zones, they made a spreadsheet and had members flyer at locations in those zones. They ended up successfully helping about 10 people. The process itself was time intensive—it took about 45 minutes to complete each application.

Overall, they found it was an effective way to reach some of the more marginalized members of their community one-on-one and were able to build a better understanding of their needs. This is a model that other locals could use to reach out.

Boulder DSA canvassed a few neighborhoods and had a steady flow of people coming in on the day of the sign up. They're planning on making it a regular occurrence. Probably once a month they’ll be available for a few hours at their local library to help people with the application process. Since people in the community who could use help aren't necessarily available on the same day, they’ve decided it’s a good long-term strategy, particularly as it's a fairly simple and easily replicable event to have. A next step is to get the word out around Boulder about these continuing efforts, as the chapter continues to expand and strengthen DSA’s presence in the city.

(For more information about these projects, contact Denver DSA at [email protected] and Boulder DSA at [email protected])

Christine Riddiough is a member of the DSA NPC, the DSA Medicare for All Steering Committee, and a long-time feminist activist.