Long-Term Care Commission Identifies Issues Facing America's Growing Need for Long-Term Services and SupportsBy Morris Klein
Congress mandated the federal Long-Term Care Commission to address a very complex subject in an impossibly short time. As events turned out, the Commission had only three months to conduct hearings and make recommendations once it was fully organized. By comparison, a federal advisory commission created around the same time to review rules on the use of electronic devices on airplanes needed nine months (including a three-month extension) to report its recommendations.
Identifying the Issues
We commend the Commission for what it did accomplish in this short time. It did a good job identifying many of the issues our nation needs to consider in shaping policies on long-term services and supports (LTSS) – policies more urgent as the baby boomers reach retirement age and the phase in their lives where long-term services and supports may be required. Among the recommendations made in their report, the Commission:
- Proposed an improved focus on quality across settings of LTSS – with particular attention to home and community-based services. It suggested the promotion of services for persons with functional limitations in the least restrictive setting appropriate to their needs – building a system, including Medicaid, with options for people who would prefer to live in the community.
- Advocated for new models of public payment that pay for post-acute and long-term services and supports on the basis of the service rather than the setting.
- Suggested integration of LTSS with health care services in a person- and family-centered approach.
- Proposed non-specific improvements in the working conditions for care workers.
These recommendations can serve as a basis to educate the public and policy makers.
Most Americans Unprepared
to Pay for Long-Term Care Needs
Yet, the Commission fell short in one key area. As pointed out in a report written by five dissenting commissioners, it failed to recommend a clear path to finance LTSS. This report offers two alternatives:
- Enhanced private financing and
- Strengthening of a public support program.
It is undisputed that most Americans are unprepared for paying for long-term services and supports if such care is needed. It is also undisputed that many people either cannot afford or are medically unqualified for long-term care insurance. The Commission did not advance the discussion on this vital topic far enough. It should have provided more direction in this critical area.
Needs Consensus on the Issue of Financing Long-Term Care Needs
Finally, the Commission proposed a national advisory committee to continue its work. We support this. Although the Commission provided a template for public dialogue, it was unable to come to a consensus on the most important issues of financing and the balance between public and private roles. The momentum it has created should continue for this issue to be resolved so the elderly and disabled can receive long-term services and supports with dignity and financial security.