U.S. Senate Special Committee on Aging Ponders Future of Long Term Care - Part I

On April 18, Senator Herb Kohl Chairman of the U.S. Senate Special Commmittee on Aging convened a hearing to consider how best provide and finance long-term care services and supports (LTSS) for millions of Americans. In his opening remarks, Sen. Kohl recited sobering statistics: current cost for LTSS is more than $300 billion a year and Medicaid alone projects $1.9 trillion in costs over the next 10 years with an annual average increase increase of 6.6%. He noted that America is going to have to do more with less: finding more efficient ways to provide care because (Federal and state) money will not be there.

Two themes emerged from  the testimony given by a distinguished panel of experts: innovation is critical to expanding the capacity and efficacy of the LTSS infrastructure, yet encumbered by the Medicaid program's exclusive reliance on skilled nursing care (by design), and secondly, stakeholders are uncertain as to how to encourage Americans to take responsibility for funding their future long term care needs.

John O'Brien, Director of Healthcare and Insurance for the U.S. Office of Personnel Management (OPM) spoke at length about OPM's federal long-term care insurance program (FLTCIP) as authorized by Congress for Federal employees (and active duty military personnel) in 2000 and introduced in 2002. Like all LTCI policies, the Federal plan is designed to protect against having inadequate assets to cover the substantial costs needed to pay for long-term care. As a voluntary 100% employee-paid benefit, by February 2003, 187,000 individuals were enrolled and by April 2009 enrollment increased to 224,000 enrollees. Is is interesting to note that for the first time in 2011, same-sex domestic partners of Federal employees had the option to apply for coverage: a direct result of President Obama's June 2010 memorandum directing agencies to take action to extend benefits to the same-sex domestic partners of Federal employees consistent with existing law.

Increase educational initiatives during the 2011, open enrollment period through multiple channels (e.g. webinars, direct mail, payroll notices etc.) increased enrollment by over 45,000 applications.  Noticeably absent in Director O'Brien's testimony was any mention of the participation rate. It is worth noting that the eligible Federal employee pool seems to be approximately 2.6 million (not including active duty military personnel and postal employees who are also eligible for coverage), which would mean that far less than 10% of Federal employees and selected this coverage. Low participation rates is the bane of those who believe that private long term care insurance can be a viable funding source for LTSS.

The testimony provided by Loren Colman, Assistant Commissioner, Continuing Care, Minnesota Department of Human Services, should be read by anyone who is interested in reforming the LTSS infrastructure in Illinois. Minnesota is widely recognized as an innovator for developing a robust LTSS infrastructure and Mr. Coleman's remarks reflected that sensibility:

We know that the preference of most older Minnesotans is to remain in their home. We want to further empower older Minnesotans to make that choice by making home and community-based services the norm in Minnesota and institutional care the exception.

Last year, Minnesota ranked Number One among all states in the first-ever AARP Scorecard on Long-Term Services and Supports for Older Adults, People with Disabilities and Family Caregivers. I've written previously (here) about this landmark initiative and it worth repeating that Illinois ranked 23rd on this same tool. In his testimony Mr. Colman emphasised the policy initiatives Minnesota pursued over the past 25 years – to reduce reliance on institutional care and encourage access to services in home and community based settings. Examples include:

  • Consolidating the policy areas for aging and adult services, disability services, nursing facility rates and policy and the Minnesota Board on Aging into the part of the Department of Human Services.
  • Ensuring a solid alignment of services delivered under Medicaid and the Older Americans Act creating a continuum of care.
  • Successful collaborations with the industry have contributed to right-sizing the number and distribution of nursing facilities in the state.
  • Promoted innovation in care through incentive payments for performance. The median length of stay in a Minnesota nursing home is now less than 30 days as services become more rehabilitative in nature.
  • Creating a Senior LinkAge phone line, which annually serves 89,000 older Minnesotans and their families, and the complementary Disability Linkage Line and Minnesotahelp.info website.

From Assistant Commissioner Colman's perspective  Minnesota has worked successfully to rebalance its long-term care system, and is developing initiatives (chiefly to promote purchase of long term care insurance) to address the coming age wave. Next week's post will continue the testimony and my thoughts about the relevancy of this hearing on the LTSS infrastructure in Illinois. What do you think?

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    Bruce Lederman

    Bruce Lederman has over 25 years experience in the senior care field as a direct care provider and thought leader. Bruce was CEO and president of his own firm that operated skilled nursing facilities in Illinois. He is a former nursing home administrator and has consulted to numerous elder care providers on planning for strategic growth as well as process improvement. Recently he served as board chair of CJE SeniorLife, a leading non-profit elder care provider in the Chicago area. Bruce is currently employed as chief strategy officer for a company providing skilled nursing services in communities throughout Illinois and Missouri.

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