Reagan Proposal Omits Nursing Home Coverage : House Panel Hears Pleas for Long-Term Care for Aged

Missy Warfield sold her mother’s car, jewelry, a bond and finally the apartment to keep paying a nursing home $2,400 a month to care for her bedridden mother, who can barely swallow food.

Warfield, on the edge of tears and her voice breaking, told a congressional hearing Tuesday, “I can remember her looking at my sister and me and saying: ‘I worked hard all my life, and you’ve sold my home out from under me.’ ”

Emotional Drama

Warfield’s testimony before the health and long-term care subcommittee of the House Select Committee on Aging, represented the kind of emotional drama that marked the hearing, the first since President Reagan endorsed a plan offering unlimited days of hospital care for Medicare recipients.

The Administration’s proposal, which does not cover nursing home costs or the expenses of treatment at home, is “the step of a dwarf, timid about going forward,” said Rep. Claude Pepper (D-Fla.), chairman of the subcommittee. “I want the so-called middle class to realize what jeopardy they are in, what vulnerability they are exposed to.”

But Richard Teske, deputy assistant secretary of health and human services, said in an interview: “Certain individuals always seem to criticize anything short of complete national health insurance. We believe this is a courageous step and does promise the peace of mind senior citizens deserve in this country.”

What the Administration and many members of Congress fear most is the considerable costs of any substantial expansion of Medicare benefits beyond current services. The Administration proposal would limit out-of-pocket costs for hospital and doctor bills to $2,000 a year for each beneficiary.

$1.8 Billion a Year

The program, aimed at helping patients cope with financially catastrophic illnesses, will cost $1.8 billion a year, financed by an additional $4.92 a month in payments by the 30 million Medicare beneficiaries.

However, the plan offers no help with health problems that are more common but can be just as devastating as the so-called catastrophic ailments, said Dr. Edward Campion, chief of the geriatrics unit of Massachusetts General Hospital.

“What patients fear are the costs of chronic disease which fall to them for prolonged rehabilitation, for complex home care programs . . . and especially for nursing home care,” Campion said. “The devastating tragedies are common: the stroke which paralyzes function, the hip fracture which threatens independence, Alzheimer’s disease which obliterates a mind.”

Many of these problems commonly accompany old age, forcing elderly people into nursing homes. Neither Medicare nor most private health insurance policies will pay for ordinary, custodial care in a nursing home. Patients and their families now spend about $17 billion a year in their own funds, with the typical bill running $22,000 a year.

Another $17 billion is paid by Medicaid, the federal and state welfare program. But patients qualify for welfare only after wiping out their savings and other assets and applying pension and Social Security payments to the nursing home costs.

Frederick Schaefer, 79, of Wheaton, Md., told the subcommittee about selling his family home and spending $70,000 in savings over two years to cover the nursing home bills for his wife, a victim of Alzheimer’s and Parkinson’s diseases. “My wife, Ruth, and I thought we were set for life,” he said.

“My parents hadn’t ever dreamed they would end up this way--destitute,” said Iona Gilbert of Falls Church, Va., whose 91-year-old father is in a Florida nursing home, which has claimed his savings, oil company pension and Social Security check. Her 89-year-old mother is allowed to keep $209 a month for her living expenses. “I ask you, who can live on $209 a month?” Gilbert asked.

Debilitating Syndrome

Missy Warfield’s mother isn’t on welfare yet. But she is 78 and suffers from Shy-Drayer syndrome, whose victims “are unable to blink, swallow and perform other basic functions with any regularity,” Warfield said.

“The $50,000 we now have in a fund to use for her nursing home care will run out at a time when we have two children in college,” said Warfield, of Rockville, Md. “I don’t need to tell you how expensive a college education is these days.”

Julia Blackwell, reclining in a hospital bed with a breathing tube in her nose, was a silent witness at Tuesday’s hearing. She suffers from arthritis and lung problems and has been a hospital patient since 1982. The bills exceed $1 million.

A nurse read a statement from Blackwell: “It’s too late to help me, but I hope that something can be done to provide appropriate long-term care outside the hospital, for others with a catastrophic illness.”