The Federal Commission on Long Term Care Issues Final Report

With the potential federal government shutdown, the Syrian civil war and the Navy Yard killings in the news, it is not surprising that the recently released final report of the federal Commission on Long-Term Care received scant attention in the media. Although a few perfunctory articles appeared, the recommendations neither stimulated public debate about how to address the provision of long term services and supports (LTSS) for 78 million boomers, nor did it provide much for elder care providers, advocates and regulators to ponder. Yet, I view the publication of the report as a moderate success.

The Commission was created as part of last year's fiscal cliff deal and was tasked with advising Congress on how to reform LTSS. Many suspected at the time of its creation that with a six month deadline and a budget of only $500,000 there was zero likelihood that the Commission could generate any far-reaching or meaningful recommendations. Despite these restrictions, the Commissioners and staff judiciously worked to gather meaningful testimony from a variety of academicians, industry representatives, advocates and others during the four hearings convened during the late-spring and summer. To those who are disappointed that the resulting recommendations consisted of well-known approaches to the provision of LTSS and contained no bold initiatives or payment recommendations, I point to the 1990 the Pepper Commission, which spent much more time and money and achieved no greater results.

Those judging the Commission's final report harshly, should also consider how Washington's current toxic climate chokes off any attempt to compromise. The very fact that this bipartisan Commission (nine members were appointed by Democrats and six appointed by Republicans) were able to issue recommendations without being held hostage to doctrinal "truths" of one sort or another, is an accomplishment in itself. Of course, this does not mean that all was hunky-dory, as the dissent of five commissioners to the final recommendations attests (here). These five commissioners clearly were seeking recommendations not included in the Commission's final report including: a new social insurance program for LTSS, living wages for home-care workers and richer Medicaid benefits among others. Fissures also seem to be appearing regarding addressing the needs of the non-elderly disabled: the full report paid scant attention to this issue. On September 23, the five dissenting commissioners issued their own 17-page, alternative final report (here) including six recommendations including a new LTSS benefit under Medicare Part A, paid for by an increase in payroll taxes or premium supports. Although I respect their passion and subject-matter knowledge, do these commissioners believe that the political climate currently exist for an increase in payroll taxes? What's their strategy here?

The press releases of elder care advocate organizations such as LeadingAge, the NOCA, AHCA and AARP indicate that although pleased with the Commission's report, the elder care ecosystem is looking to Congress and the Administration to do the critical work of addressing how to pay for LTSS for older adults and persons with disabilities. Perhaps this report can be the spark for that process to begin.

Older adults begin to rely on LTSS in significant numbers around the age of 75. With the oldest boomers approaching age 68, there are only a few years left to erect the payment systems and provider networks necessary to meet the needs of the largest generation of Americans. What do you think?

Learn more on Twitter @aginginchicago


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    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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