Why is this dirty secret about the potential crisis in long-term nursing being avoided by the press and the politicians? Is it possible an imminent nursing home crisis will dwarf the monetary crisis dominating political debate today? Could tens of thousands of citizens soon be abandoned on the streets, too weak and too sick to fend for themselves, without proper meals and care, disoriented and disabled by disease? We think this scenario is possible!

Could baby boomers and those nearing retirement find themselves rejected by nursing homes for lack of room? Could costs be so high that only the fortunate few who have sufficient money and power be the only ones to afford access to long-term nursing care? There is a clear possibility these events can occur unless we begin to take responsibility for the realities of a population soon to have 30% of its members older than age 65.

Will there be sufficient financial resources, either public or private, to pay the bills? We think not! Are we treating elder care as a ho-hum subject taken for granted? Do we assume that without planning, adequate and affordable care will be available when needed? In our view planning is totally lacking, and the consequences to society could be devastating.

Who is planning how many beds will be needed to handle the aged in five years, in ten, in 15 years? What can be expected when the baby boomers reach the age where 6.6% (or 3.5 million disabled) of those over age 65 will require long term nursing care ? In the year 2010, 60 million citizens will be older than age 65.

For the past 50 years the total nursing home population averaged 6.59% of citizens over age 65. This percentage won't change materially. While people do now live longer, many also require more care. Within 15 years, 3.9 million nursing home beds will be needed according to analysis of data published by the Division of Health Care Statistics, U.S. Department of Health and Human Services, the Population Reference Bureau, Inc., and the AARP, in State Profiles.

In 1994 there were fewer than 2.3 million available beds. 1.7 million new nursing home beds must be added to the system within the next 15 years if the oncoming crisis is to be avoided.

Long term nursing care, excluding medical expense, currently consumes $82 billion from the public and private sector. This will increase to $240 billion in 15 years. We must find alternatives to the present trend of litigation, regulation, mandated expenses, and medical inflation, which are pushing costs to unaffordable levels?

In 1994 the average cost for a nursing home bed was $37,000 annually, according to State Profiles. One year of nursing care now consumes 10 years savings? In a very short time all but the super-wealthy go bankrupt.

Analysts expect the cost of long term nursing to exceed $60,000 annually in 15 years. How can any family expect to accumulate sufficient resources to fund private care for a period ranging from two to seven years at a cost of $5,000 a month?

Where does a family obtain the needed funds today? Less than 1% is funded by personal insurance. Usually the family farm or home must be sold and the life insurance policies cashed-in. Money that was saved for 50 years to help pay for retirement or a grandchild's college is quickly exhausted. Within three years the patient, and usually the entire family will require public assistance.

How long will we have to wait before our leaders acknowledge that long term care is breaking the back of Medicaid? The 1.2 million patients currently being funded by taxpayers through Medicaid consume more $41 billion from State and Federal Budgets. This cost doesn't include the additional medical expenses incurred by the same nursing home residents. Within 15 years this taxpayer-funded Medicaid expense will increase to $118 billion excluding medical.

With an unaffordable $41 billion outlay today, how can the taxpayers expect to fund almost triple this amount, or $118 billion for the Medicaid portion alone, within 15 years?

How do we expect to afford the additional construction expense of building new facilities when mandated Federal, State, and local regulations, legal expense, and inflation have driven construction costs to exceed $60,000 per bed in 1996 dollars?

When future costs of long term nursing care exceed $236 billion, every man, woman, and child in the United States will share an additional $400 in tax burden. Some may feel financially comfortable and regard this as a problem to be solved by someone else. The affluent will bear an inordinate and perhaps crippling proportion of the additional taxes. These additional taxes could wipe out an estate which otherwise would have been adequate.

Can operating costs be controlled? Does the public have the courage to demand litigation reform to reduce the costly onslaught of lawsuits which adds billions to the cost of nursing care. We are told that fraud in the nursing home industry exceeds $10 billion, and ranges between 10% and 20% of budgets. Can workmen's compensation and Medicaid be made accountable to control the billions skimmed from the system by almost every hand that touches these public funds.

Shouldn't we be alarmed about this lack of a serious dialogue underway in media or the political arena? How can we plan and create solutions when no-one is discussing the issues. How can we develop alternatives and solutions if this subject continues to be buried while the lack of nursing home capacity continues to approach critical levels? Could it be that the problems are so overwhelming, and the prospects so frightening that no-one in power dares to put the subject on the table? Why haven't leaders in politics, the press, and industry taken the initiative to explain the multitude of challenges. Why is the population blissfully unaware of the magnitude of nursing inadequacy? Is the public interested? No one is planning, and no one is talking. Can we really expect to meet these challenges when individuals and government are in apparent denial about the needs of our aging population?

Why are consumer groups, politicians, and associations of seniors opposing changes in Medicaid at a time when the country is clearly facing a potential catastrophe possibly greater than all the wars which have been fought by American soldiers? Why doesn't someone with a voice blow the whistle?

Assuming that costs are controlled, and that the needed new beds are constructed, will the end result be affordable? We think not. When the cost of caring for one senior exceeds three years gross wages earned by the average citizen, something is clearly wrong.

We believe that adding new beds and controlling the escalation of costs may be too little and too late to solve the problems. The cost of long term nursing care in the U. S. will continue to outstrip the ability of individuals and government to pay the bill. Innovative alternatives that can improve the quality of care, and substantially reduce the cost must be developed.

The American entrepreneurial spirit has always found a way to meet the challanges of change. In this crisis which is larger than the private and the public sector combined, can the necessary and innovative solutions be developed in time?

There are bold new solutions being investigated by innovative and visionary entrepreneurs. Will we join them to solve the problems? Or will we deserve to be remembered by history as a land of promise populated by barbarians unwilling, and perhaps unable to care for our parents, grandparents, and fellow citizens no longer to manage their own lives without help?

JOHN LANGHORNE, JR. P. O. BOX 530586 MIAMI SHORES, FL 33153-0586 305-751-7763 e-mail 73330.2766@compuserve.com

QUESTIONAIRE Please answer the following questions, then e-mail or FAX your response to the above address or phone number. Your views will be incorporated in a follow-up article. Thanks

What is your opinion relative to the quality of care in nursing Homes?

• Care is generally excellent __________
  
• Care is generally poor ______________
  
• Medication levels are appropriate __________
  
• Medication levels are excessive ____________
  
• Patients receive adequate exercise __________
  
• Excercise is inadequate _____________
  
• Nursing Homes are well designed ,______________
  
• Nursing Homes are poorly designed ______________
  
• Nursing Homes have sufficient caregiver Staff ________________________
  
• Nursing Homes have inadequate caregiver Staff ______________________

• Average cost of nursing homes in your area $_________________monthly

• Beautiful, first class Resort Location
  
• Warm Climate - Outdoor recreation all year
  
• Within 20 minutes of major airport
  
• Caregiver to patient ratio about 2 patients per caregiver
  
• The highest quality of caregiver attention to patients
  
• Emphasis on homelike atmosphere for nursing home patients
  
• Up Front Custodial Patient Fees not to exceed $10,000
  
• Monthly Cost for Full Nursing Care $1,500
  
• Resort accomodations/recreation for visitors
  
• Retirement Villas of highest quality
  
• Villa rental no more than $1,000 monthly
  
• Minimal up-Front Fees for Villa Rental

Please rank the following in order of importance, with (1) being most important, and (3) least important:

• Quality of Caregiver Services ___________
  
• Cost of Caregiver Services ___________
  
• Distance from present location ___________

Because of the serious issues raised in the article, and the fact that media and government officials are not discussing them, please feel free to take a copy of the article to your local seniors publication, or to any publication where you might create enough interest for them to publish the article. In this way, perhaps we can create some meaningful distribution. thank you, Jack Langhorne, author and researcher.