This blog post first appeared on HealthCetera, from the Center for Health, Media & Policy at Hunter College, where I’m a Senior Fellow.
The Federal Long Term Care Commission issued its final report last week –adopting 28 recommendations addressing home and community based care, increased support for family caregivers, better workforce training and compensation, and a push away from a knee-jerk adherence to “institutional first” transitional care. That’s good news for the millions of disabled and older adults requiring some level of long term services and support.
But there’s this one problem.
The Commission couldn’t agree on how to pay for it. Instead of reaching consensus on payment reform, a split committee proposed different approaches – one focused on private market solutions and the other on public programs to finance these recommendations. A little insurance, a little personal savings, a little government help, perhaps some changes in Medicare rules… it was difficult to determine what, if anything was really on the table.
To make matters worse, six commissioners voted against presenting this as the panel’s final report. They refused to whole-heartedly condone the document primarily because of the nebulous statements on financing.
The Commission was formed as part of last year’s fiscal cliff deal to address issues that the repealed CLASS Act, was supposed to take care of. The CLASS Act offered Americans some real options for long term care coverage and was part of the original Affordable Care Act. It was axed when the final numbers didn’t work out as proposed.
Commissioners only really began work on these issues in June and there was little optimism that anything substantive could be accomplished in the 100 or so days left in their mandate. Throughout the summer, they heard testimony from long term care experts and advocates. A final report was required by mid-September and they managed to meet the deadline. But once again, older adults and others who need ongoing services and support are left hanging.
It’s highly doubtful a fractured Congress will come to quick agreement on financing any — let alone all — of the Commission’s proposals. Several Commissioners plan to write their own reports, with more of their specific ideas on costs and coverage. Conceivably as many as a half-dozen different versions could end up on legislator’s desks.
The long term care crisis is real, and it’s only getting worse. 12 million Americans currently require some type of long term support. Aging baby boomers will swell the ranks of seniors to nearly one-fifth of the population by 2030, according to the Scan Foundation, while the availability of caregivers – both family members and paid workforce – are declining. Costs of care are increasing, strain on family caregivers, and strain on the system is nearly at the breaking point already.
The Commissioners recognize that the report falls short. They urged Congress to view the document as a jumping off point for more refined proposals, additional committees, and alternative financing approaches. If there’s movement at all on these recommendations, it will be incremental at best.
How do you tell an 85 year old who could remain in her own home with just a little help, to wait?
How do you tell the son or daughter of a parent with Alzheimer’s that respite care is being “negotiated?” What can prevent someone from spending down nearly all of their assets because it’s the only way they can qualify for Medicaid-financed nursing home care?
Real solutions to improve quality of life, and quality of care for a significant portion of our population are in the pages of the Commission’s report. Unfortunately, the missing piece of the puzzle leaves millions still grappling with the same issues, and no relief in sight.