TV REVIEW : A Grim Report on Long-Term Health Care

Is the expense of long-term care for the elderly a private or social cost? In a country so driven by the private marketplace and personal responsibility, the question would seem to answer itself. But the grim, chastening “Frontline” report, “Who Pays for Mom and Dad?” (tonight at 9 p.m., Channels 28 and 15, 10 p.m. on Channel 50) throws the issue out on the table for fresh debate.

When it comes to long-term elderly care, at least, free-market approaches may have reached the end of the line. Writer-producer-director Elizabeth Arledge takes as her painfully living model the Lombard family: Dan Sr.’s wife, Rose, is in decline due to Alzheimer’s disease, and Dan Jr. must find the best means to take care of her. Dan Sr. doesn’t want to put her in a home, and there are good reasons beside emotional ones.

With annual nursing care costs currently averaging $30,000 (for the Lombards’ Boston area, the average is $45,000), families supporting their incapacitated loved one must “spend down” to the poverty level in order to receive Medicaid support. Decades of life savings can be wiped out in weeks, but such money-saving schemes as attorney Harley Gordon’s--to use Medicaid law loopholes and stash away funds before spending down--have come under harsh criticism from public health officials and industry-watchers such as columnist Jane Bryant Quinn.

Arledge shows that by beating the system Gordon’s way, the amount of public and private funds for truly needy patients will soon dry up. But she also shows that until Washington hatches a federal program for long-term care that offers a mix of public and private funding, the loopholers are only shrewdly using the law to their advantage.

Reading between the lines of “Who Pays for Mom and Dad?,” it’s clear that the Graying of America is going to cause some radical changes in the national budget--and national values.