Long Term Care Reform Proposal 1

Author: Megan Precht
Why long term care in the United States needs to be reformed:

· The elderly are the biggest long term care users and the number of people ages 70 and older needing long term care will increase from what is now roughly 10 million to 15 million in 2020 with an estimated increase to 21 million in 2030. This is due in part to the aging baby boomer population.
· If the nation’s long term care policies and financing stay the same we are going to see an even greater cost increase in health care overall because so many will need long term care services.
· Long Term care is not accessible to everyone and this is a huge problem. Many believe that Medicare should cover the cost of long term care services, but this is simply not the case. Below are the generally eligibility requirements for Medicare as well as a statement taken from the Medicare website concerning long term care.

"Medicare generally doesn’t pay for long-term care. Medicare also doesn’t pay for help with activities of daily living or other care that most people can do themselves. Some examples of activities of daily living include eating, bathing, dressing, and using the bathroom. Medicare will help pay for skilled nursing or home health care if you meet certain conditions."

Our idea of reform:

First let’s address the issue of cost…

Here is what the US Department of Health and Human Services says about long term care costs:
“Costs for long-term care services vary greatly depending on the type and amount of care you need, the provider you use, and where you live. For example, many care facilities charge extra for services provided beyond the basic room-and-board charge, although some may have “all inclusive” fees. Home health and home care services are usually provided in two-to-four-hour blocks of time referred to as “visits.” An evening, weekend or holiday visit may cost more than a weekday visit. Some community programs, such as adult day service programs, are provided at a per-day rate, and rates may differ based on the type and variety of programs and services offered.”

· The US government needs to assess how money is spent when it comes to health care. Why is it that the US is spending more than any other nation? Health care costs consume 16% of our national GDP, and we know that number is continuing to grow. Other nations that have developed national health care plans are spending much less. We can no longer survive as a nation without a unified effort to manage cost. Treating our population as health care consumers who must abide to the rules of the cost of long term care as stated above isn’t working. We propose that the US government in preparing for the surge of long term care users develop a public long term care insurance program (which could basically be a reform of Medicare that would be financed differently and made less complicated). This program will be financed through a global budgeting system so that the cost of long term care for this population will be addressed in the most efficient way possible. All long term care facilities will be subject to this system.

Now let’s look at the accessibility of this program…

· This program should be made accessible to anyone 65 years of age and older, as well as to those who are developmentally or physically disabled (including being disabled by a chronic disease) and in need of long term care. We as a nation should hold ourselves responsible for caring for those who cannot care for themselves and access to long term care should not be denied to anyone meeting these general qualifications.

Finally let’s discuss what this reform means for quality…

· Our hope is that quality of care will become the competitive factor for long term care facilities if costs are streamlined. If facilities cannot lower costs to attract customers than they will have to turn to their quality of care to remain competitive as a business.

Altman, Stuart H., and Alan B. Cohen. "Commentary." 1993. Health Affairs. 28 Feb. 2009 http://content.healthaffairs.org/cgi/reprint/12/suppl_1/194.pdf.

Medicare The Official U.S. Government Site for People with Medicare . 17 Sep. 2008. Centers for Medicare & Medicaid Services. 28 Feb. 2009 http://www.medicare.gov/MedicareEligibility/Home.asp?dest=NAVHomeGeneralEnrollmen.

National Clearing House for Long Term Care Information. 22 Oct. 2008. U.S. Department of Health and Human Services. 28 Feb. 2009 http://www.longtermcare.gov/LTC/Main_Site/Understanding_Long_Term_Care/Costs_Paying/.

Shi, Leiyu, and Douglas A. Singh. Delivering Health Care in America: A Systems Approach. 4th ed. Sudbury, MA: Jones and Barlett Publishers, 2008. 381-82.