AAHSA Board Member Takes on LTC Financing in New York Times Blog

August 28, 2008 by Sarah Mashburn
excerpted from AAHSA

I’ve written before about The New York Times “New Old Age” blog. This new publication features a variety of perspectives on the issues facing our aging population and those who care for them. Today, that included a commentary from AAHSA board member Kathryn Roberts. Kathryn is the CEO of Ecumen, one of the country’s largest not-for-profit providers. She’s also a passionate advocate and is working hard to help us advance our Long-term Care Solution. Check out her take on why the presidential candidates aren’t addressing long-term care, and why these leaders are missing out on an important opportunity:

Why Are the Candidates (Mostly) Silent on Long-Term Care?

My generation put day care in workplaces, gave rise to pediatricians and drove minivans and hybrids to market. Could transforming how we pay for aging be the baby boomers’ next big act?
Today about 10 million Americans need long-term care; 12 million will need it in 2020.

Should our primary option be a Cold War-era nursing home for which we largely pay with personal bankruptcy? No. I believe most Americans desire living fully — and differently — to the very end of life.

Unfortunately, as the unprecedented age wave rises, America sits in a costly time warp. We’re flying a 1965 aircraft — the Great Society programs of Medicare and Medicaid — absent an overhauled engine. While other countries have coordinated home- and community-based services for young and old with physical challenges, our outdated way unnecessarily, and expensively, institutionalizes people.

Medicaid pays nearly half of long-term care expenditures in the United States, costing federal and state governments $116.8 billion every year, according to the Kaiser Commission on Medicaid and the Uninsured. American businesses lose as much as $33.6 billion in annual revenue because of employees’ need to care for family. That’s about $2,110 per full-time employee who is also a caregiver, according to the MetLife Caregiving Study. There is a better way.

So why are the candidates generally silent on these issues?

Though Senators Barack Obama and John McCain each authored books, they’ve penned and spoken few words on long-term care. I see several reasons for this silence.

One is language. When people hear “long-term care,” their mind typically sees an outdated nursing home they want to avoid. Not great fodder for a stump speech. But long-term care is becoming much more, from independence-enhancing technologies to intergenerational respite centers. At its best, it’s empowered living, and we need new language and images reflecting that.

Second, most policymakers, like most Americans, know little about long-term care. Last year we surveyed Minnesota baby boomers, asking them who pays for long-term care. About a third said Medicare. It might pay for 100 days of rehab, but not for the care of those with memory problems or other intensive needs.

Third, Senators McCain and Obama, unlike most Americans, are somewhat insulated from this issue. When the candidates need assistive services, their private dollars will likely afford them top home services or posh senior housing rather than Medicaid-funded options.

Fourth, policymakers separate long-term care and health care. But the two are tightly intertwined in the kind of preventive, integrated cradle-to-grave health care for which Americans yearn but haven’t delivered on. Long-term care, in fact, could be a doable door opener to overall financing reform.

Fifth, we volley care between either-or’s. As in: either government pays for care, or private long-term care insurance pays. Neither is working. About 5 percent of Americans have long-term care insurance, and even if everyone purchased the best policy he or she could afford, Medicaid costs would still triple. Like most good public policy, the sweet spot lies somewhere in the middle.

Finally, aging and care lobbies (which include every American, because we’re all aging) have not cohesively raised voices around solutions. That will change, because the stakes in terms of life quality and economics are too high and too interconnected to our collective success.
A tremendous opportunity sits before every candidate and citizen who wants to transform America for the 21st century. It’s called long-term care financing reform.

Kathryn’s right. Long-term care financing doesn’t have to be an obstacle for McCain or Obama. It can be an opportunity to attract potential voters, build a legacy, and most important, help make it affordable to care for millions of aging and disabled Americans.