By Gene Coffey, staff attorney, National Senior Citizens Law Center

U.S. News & World Report magazine ran a cover story last fall entitled Taking Care of Mom & Dad: A Boomer’s Guide. The cover featured an older woman seated in a chair with her daughter standing above her. The daughter’s hands were resting on mom’s shoulders, a sign of affection and preparedness from daughter, a sign of safety for mom.

The story was designed to give very specific information about finding the most suitable environment for older individuals who may reach a point where they may not be able to live alone. But the story’s title–Taking Care of Mom and Dad–reflects more broadly the very personal connection we all have with older Americans, and the accompanying responsibility we all share in ensuring that their safety and dignity is maintained throughout the aging process. The fact that the story was designed to be a "Boomer’s Guide" is a reminder of just how high this responsibility will rise in the coming years with the dramatic increase in our older population.

The affection and preparedness portrayed by the daughter on the cover matches with the reality of our current efforts. While $200 billion is spent each year in the U.S. on long-term care services, the majority of long-term care provided in this country is actually delivered for free by friends and family of those in need of care. For care that is paid for, the children of those in need are already paying quite a bit. Indeed, the New York Times ran a story this past December on the extent to which adult children of frail parents are rapidly going through substantial portions of their own savings to pay for their parents’ care.

But while our own responsibilities will increase in the coming years, we will need our government to partner with us in facing this vital task. Shouldn’t we be able to rely on this? Unfortunately, some recent stories seem to indicate that we have reason to be concerned.

The U.S. Government Accountability Office (GAO), a federal government agency, reported in March that lax enforcement by federal officials of nursing home quality-of-care standards has allowed the worst nursing homes in the nation to remain open and continue to provide poor care. Citations for harm to residents have continued to pile up for these facilities, but the fines levied by federal officials responsible for enforcement have been so weak that the facilities, as the GAO reports, have been able to simply include them as part of their operating costs. Think about this for a moment. The level of federal oversight of some nursing homes in this country is rendering the infliction of harm on residents a routine part of doing business.

But this is not all of the bad news the GAO had to deliver. The agency also reported on a survey it conducted on Medicaid long-term care applicants. Medicaid is the single largest payor for long-term services (e.g., nursing facility services) in the nation. Medicare does not cover more than 100 days of care in a nursing facility, and the private cost of care is roughly $70,000 annually, so Medicaid serves as a vital safety net for individuals who need long-term care.

But some members of Congress insisted last year that many older Americans and persons with disabilities were transferring fortunes to family members in order to avoid paying for their long-term care, and were subsequently qualifying for Medicaid after their fortunes were gone. To address this alleged problem, Congress enacted severe penalties for Medicaid long-term care applicants who have made any financial gifts in the five years preceding application. Assistance for a child purchasing a home, or for a grandchild’s college tuition, or even a donation to a church will result in an eligibility penalty for an applicant.

Was this punitive law even necessary? Not according to the GAO’s results. You know what the agency found? That people who seek Medicaid coverage for long-term care are poor, that they generally do not have a lot to give away, and where they have made gifts, the gifts have been small. Under the new rules, however, those small gifts will result in eligibility penalties.

The congressman who asked the GAO to conduct the study proclaimed, "The report confirms that the Medicaid long term care program is not rife with cheats and scam artists. The seniors who enter nursing homes and end up being covered by Medicaid are truly needy." Unfortunately, this isn’t much of a consolation to those who will be subject to the punitive penalties that Congress has produced.

For those capable of contributing more to their long-term care, the news does not get much better. The same federal law that instituted the harsh new Medicaid eligibility penalties also tried to create incentives for the purchase of long-term care insurance. Is long-term care insurance something the federal government should be promoting? One might have some questions after reading a New York Times story published in March that reported on the "thousands of grievances and lawsuits" that have been filed in recent years by holders of long-term care policies. In California, nearly one in every four claims has been denied. The person profiled at the outset of the story spent twelve years paying for a policy to a company that refused to cover her nursing home expenses when she moved in. At the time, she had been diagnosed with early-stage dementia, suffered from hypertension and diabetes, and took 37 different pills a day. The company said she wasn’t sick enough.

These stories are not reflective of a federal government ready, willing and committed to fulfilling its role in helping our older population respond to the challenges facing them ahead. As individuals, we need to make own efforts to help our parents and grandparents feel secure, but our government should feel equally moved to cast this same sense of security. Apathy, and in the example of the new Medicaid transfer rules, disdain seem to have characterized the federal government’s most recent demeanor toward our older population. Yes, we recently witnessed the addition of a drug benefit to the Medicare program, but wouldn’t the program make us more confident about the federal government’s attitude if a member of the majority party that got it passed in Congress did not declare on 60 Minutes that "the pharmaceutical lobbyists wrote the bill"? (By the way, the GAO released a report on the Part D program earlier this month that faulted CMS for its treatment of the poorest Medicare enrollees. According to the GAO, CMS "objected to what it perceived as the overwhelmingly negative tone" of the findings.  Do tell.)

It was Harry Truman’s compassion that President Johnson identified as the catalyst behind the government action that produced the Medicare program in 1965. With ever more dramatic challenges facing older Americans in the immediate future, the federal government must signal that this compassion is still present on Capitol Hill, so that older Americans may feel secure that its government will take action to address the problems that surface. Our loved ones deserve nothing less.