In December of last year, the Senate Special Committee on Aging,currently chaired by Senator Bill Nelson with Senator Susan Collins serving as its ranking member, convened a hearing on the future of long term care policy. With 74 million boomers beginning to enter the long term services and supports (LTSS) ecosystem, the importance of this subject cannot be overstated.
The Committee heard from eminently qualified experts from the elder care space including Anne Tumlinson MMHS, as well as three members of last year's federal Commission on Long Term Care (Commission): Judith Feder PhD, Mark Warshawsky and Bruce Chernof MD. The Committee is current chaired by Senator Bill Nelson and Senator Susan Collins is its ranking member. Among the twenty Committee members, Senator Tim Scott unique background in selling long term care insurance (he is a former Allstate Insurance agent) provides him with real world experience regarding the public's intransigence when it comes to financing their future LTSS needs.
In her testimony, Dr. Feder reminded the Committee that five Commission members (herself included) felt the need to issue a separate, dissenting final report in opposition to the Commission's final report. Unlike the Commission's report, the dissenting report called for public insurance to assist Americans with funding their LTSS needs, when personal and family resources are insufficient. Of course, public insurance (e.g. Social Security and Medicare) requires public resources (i.e. taxes, etc.) and in Washington's current dystopic state, it's difficult to see with way forward as outlined by Dr. Feder and her fellow dissenters.
Dr. Chernof and Mark Warshawsky submitted joint testimony which summarized the final report of the Commission on which they both served as the Chair and Vice Chair, respectively. In their testimony, they advocated for person/family-centered care provided by either well-trained family members or paid caregivers. Like the Commission's final report, their testimony did not provide specific details on how to finance this desirable outcome, but they made the case for the need to obtain new data, engage in design work and in careful analysis of costs before, "fiscally responsible proposals can be generated."
I found that Anne Tumlinson's testimony succinctly provided many salient facts that should startle even the most apathetic or partisan politician including:
- $200 billion was spent on bare-bones LTSS in 2011 ($136 billion from Medicaid and $45-$53 billion from private sources);
- Unpaid caregiving by friends and family was valued at $400 billion in 2011;
- 11 million Americans are receiving LTSS;
- One third of all American households report at least one members erred as an unpaid caregiver in the past 12 months;
- 35% of Medicaid expenditures are for home and community based services
- 1 million American are living in housing with services (the amount of private funding being spent on assisted living now exceeds the amount spent on skilled nursing facilities); and,
- 1.5 million Americans now resided in skilled nursing facilities.
Ms. Tumlinson also noted that the dual trends of ACO formation and bundled payments will improve post-acute care and are expected to lower costs, but that integration between acute, post-acute and LTSS platforms will be necessary in order to achieve the desired results.
Coincidentally, an interesting survey, published last week, focused on the topic of what is keeping home health, assisted living and nursing providers up at night. It touched on themes alluded to at the Commission's hearing and is a worthwhile read.
It will be interesting to see what action Congress will take (if any) to address (or perhaps solve) the riddle of funding America's future LTSS needs.What do you think?
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