US Senate Hears About Long Term Care Worries

United States Senate Brand IDIn 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?

Learn more on Twitter @aginginchicago



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    Hearings are always conducted and bills get proposed most of the times, I wonder where this will go with the current political situation in the US as oppositions are always in contrast. The long term care (LTC) insurance industry is a growing concern as well as the crisis in aging, but the risk of long term care seems to be misunderstood by a lot of people. Whatever happened to the CLASS act? Or the Long Term Care Insurance Integrity Act of 2012? The legislators play a crucial part in the reforms of long term care, in a report from and people are still waiting and relying on government to care for them should the need for long term care arises, however, waiting will only increase their risk of being denied a long term care insurance and if they do qualify, it would be too expensive by then since age is a factor.

  • In reply to Karen Lorenzo:

    As someone who sold long term care insurance in the past, I strongly believe in the concept. However, it is not a substitute for robust social insurance, which would augment an individual's personal savings as well as provide for those who were unable to save sufficient funds during their working years to pay for LTSS in later life.

  • fb_avatar

    I like the notion of a family-centered care for senior adults rather than sending them away to a nursing facility when this country has an "unpaid caregiving (debt) by friends and $400 billion in 2011." However, not every family has a capable member to take care of their aging senior and training them (domesticating a family member to assist the older member) is a task too painful to imagine. According to on a report they happened to release a couple months back, this would the kill half the industry if ever we focus on training people

  • fb_avatar

    I already saw this post on ACSIA but it is funny how these problems continue to persist yet it took them only late last year to notice and convene such matters to the Senate. If the figures are correct, the $400-billion unpaid caregiving value will continue to rise unceremoniously. With still no specific plans on how to address this (since they still cannot provide details on how to pay for that),the future of our older adults are still doubtable.

  • I'm often reminded of the famous quote, "If present trends cannot continue...they won't" Unpaid caregiving has a real cost to the productivity of the American workforce. However, legislators are very aware of the moral hazard created once a new government program is created. It's a difficult balance that requires more careful consideration. Thank you for your comment! To learn more, follow me 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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