Long-Term Care Reform Proposal #2

Many lawmakers and congressmen are opposed to even confronting long-term care issues.¹ They are making a serious mistake by failing to acknowledge that the chronically ill need a continuum of care that does not come to an end at hospital discharge or when they leave their physician’s office. At the present time, Medicaid is responsible for providing long-term care only to nursing home residents. Furthermore, in 2004, Medicare covered only 13.9% of the cost of care in nonhospital nursing homes². Due to the fact that states are under no legal obligation to provide home care, this assistance is often limited and poorly funded.¹

Congress continues to tackle health care reform, and we believe that any new plan needs to involve a strong long-term care component. Even though many people may be opposed to this idea because our elderly population is still very healthy and independent, there is still an immense need for long-term health care reform. Because of the aging population and the rising cost of health care, states need to search for different ways to increase quality and access while decreasing cost for the older adults and elderly. The primary goals should be higher quality, cost efficiency, and consumer satisfaction.³

Due to the large aging population, the need for long-term care will increase dramatically within the next few decades. For this reason, access to long-term care needs to become more available while remaining cost efficient. Because the elderly population is so large today and their demands are so diverse, we propose that there needs to be a large increase in a variety of institutions in the country. For example, there may be a 65 year old that just needs help getting out of his or her bed in the morning; or there may be a 65 year old with end stage lung cancer that needs to be placed in a hospice care facility. Furthermore, every day we undeniably can see how poor quality increases cost.⁴ For instance, an elderly person does not receive the proper care in his or her nursing home, which leads to skin irritation and a pressure ulcer that eventually sends this person to the hospital. Therefore, each state’s budget needs to take into account the needs of their elderly population and assess this need in order to develop more facilities that provide specific care. An emphasis needs to be placed especially on home health care.

Because our aging population is fairly healthy, many elderly adults want to remain in their home as along as possible to maintain their independence and a high quality of life. The utilization of home health care has declined due to the Balanced Budget Act of 1997, which inflicted restrictions on home health coverage for Medicare beneficiaries.² This act may have controlled costs, but it did not increase quality or access for the elderly. Moreover, home health care is much cheaper than nursing home care.⁵ However, millions of Americans who need long-term care but cannot afford to pay for even home health care, end up spending most of their assets in order to qualify for Medicaid and then move to nursing homes, which are covered by the program. This is incredibly expensive for the government because they pay about 60% of long-term care costs in the United States. Obviously this situation does not benefit anyone because the elderly have to give up their assets in order to obtain health care, which many may not even need to be in a nursing home, and the government ends up spending way more on long-term care.

As a large part of our reform, we propose that both the federal government and each state’s government work with one another in order to incorporate a change in their budget so that both Medicare and Medicaid are distributed better. If the budgets can allow for this type of change, Medicaid and Medicare could allow more money to be put into home health care rather than nursing homes. Consequently, the elderly population would be more apt to paying for home health care because they would receive some money from these programs. Therefore, these changes would decrease cost for both the elderly population and the government, increase access by allowing more people to receive care at home, and increase quality by providing one-on-one care in an individual’s home.

-Kayla Schuster

Sources-

1. Gleckman H. Will Long-Term Care be Included in Health Care Reform? Kaiser Health News. 2009. Available at: http://www.kaiserhealthnews.org/Columns/2009/September/091409Gleckman.aspx. Accessed March 10, 2010.

2. Shi L, Singh D. Delivering Health Care in America: A Systems Approach. Boston: Jones and Bartlett Publishers; 2008.

3. Folkemor D. A Guide to Long-Term Care for Policy Makers: The State of Long-Term Care. National Conference of State Legislators. 2010. Available at: http://www.ncsl.org/Default.aspx?TabId=14491. Accessed March 10, 2010.

4. Smith D. The Role of Long-Term Care in Health Reform. The Heritage Foundation. 2009. Available at: http://www.heritage.org/research/healthcare/tst032509c.cfm. Accessed March 10, 2010.

5. Pickert K. Should Long-Term-Care Insurance Be Part of Health Reform? TIME. 2009. Available at: http://www.time.com/time/politics/article/0,8599,1946431,00.html. Accessed March 10, 2010.

Long-Term Care Reform Proposal #1

Long term care is an important but often overlooked component of health care. Each year, millions of American families are affected by the health care system including long-term care. The main goal of long-term care is to help maximize a person’s independence and functioning at a time when a person is unable to be fully independent.1 Yet, when a person finds themselves in need of long-term care in this country, there is a good chance someone else is making the decisions that affect that person’s activities of daily living such as, the time a person goes to bed and when he or she eats their meals.2 Changes in current health care policies are required in order to maintain a high quality health plan that can reach as many individuals as possible.

Although the United States has not addressed the drastic problems it will soon face in long-term health care, developing a new strategy must become a top priority of the health care reform due to the aging of baby boomers. As the rapidly growing population of people over the age of 75 continues to increase, the need for a stable long-term health care plan is only going to become more pertinent. Unfortunately, many people do not find the need to reform long-term care because their age has allowed them to remain independent thus far.2

Home health care is generally far less expensive then long-term care. The cost of providing for an individual in his or her home requires less medical attention and less medical resources.3 Furthermore, individuals are often more comfortable with home health care because it provides a greater level of privacy. Therefore, for those families with a lower socioeconomic status, home health care may be the best option. However, costs vary greatly depending on where a person lives, the level of care, and the number of hours of services needed per week.4

As a part of our health reform, we propose that the federal government, as well as each individual state work together to implement a change in their budgets and policies to better help guide how Medicare and Medicaid is distributed. By implementing a strategy to re-organize the budget, we hope to increase access and lower costs for long-term health care. Each state needs to adjust their budget accordingly based on an individual state’s elderly population. This plan allows flexibility within states themselves and does not force states into dedicating a set amount of money to long-term health care.

The first step to reorganizing the budget, so that it reflects some positive changes, involves re-structuring Medicaid. If Medicaid put more money into at home care compared to nursing homes, long term care costs would decrease, allowing Medicaid to cover and reach a wider access of people.5 Patient quality would also be projected to increase. Quality could increase as a result of more individuals requesting care at home. Additionally, through home care, families would be present more often and rarely would a patient receive a lack of care due to understaffing. Our goal is to shift costs by providing less funds to people in need of long-term care and increase the funds for those receiving home health care. The costs and revenues saved from this shift as well as the increase access for people to receive home health care would be monumental. The savings built through an investment and emphasis on home health care, would allow a greater spectrum of people to be covered under a new plan. Ultimately this plan gears long-term health care in a direction we think is best. By saving money and cutting costs, this plan hopes to increase the quality of care patients receive while also increasing the number of individuals who have access to quality health care. As many baby boomers have seen through the medical attention given to their parents, the current state of long term health care is inconsistent and does not include the independence and individual care one would receive through home health care.

1. Reed, Charles. "Long-term-care reform must provide consumer choice while saving money." The Seattle Times 20 July 2009. Print.

2. Smith, Dennis. "The Role of Long-Term Care in Health Reform." The Heritage Foundation. 03/25/2009. The Heritage Foundation, Web. 1 March 2010.

3. Planning and Funding Care. Comfort Keepers, 2009. Web. 1 Mar. 2010. .

4. National Clearinghouse for Long-term Care Information. U.S. Department of and Human Services, 30 Dec. 2009. Web. 1 Mar. 2010. .

5. Medicaid: Impact on Long-Term Care. Center for Excellence in Assisted Living, Mar. 2009. Web. 1 Mar. 2010. .

-Natalie Jones