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On Nov. 8, I joined a group of long-term care experts at an Urban Institute panel discussion on the implications for long-term carein an era of shrinking government.
While the panelists opinions varied, all agreed on one fact: that long-term care in America is at a crossroads. On one hand, the Affordable Care Act offers opportunities for improving the system by encouraging pilot projects and demonstration programs as well as payment bundling and incentives for care coordination among healthcare providers.
On the other hand, the goverment's emphasis on deficit reduction could mean devastating cuts to Medicare, Medicaid and Older Americans Act programs. What does this mean for our field? According to the experts, that it's time to investigate what these dynamics mean for our field and what can be done to make them.
Take Medicare payments. Len Fishman, CEO of LeadingAge member Hebrew Senior Life, said that the changes to payments in the Affordable Care Act will focus hospitals on the first time on what happens to patients after they are discharged because of the penalties associated with readmissions and the incentive that payment bundling offers them.
It is change that could both improve quality and reduce Medicare costs simultaneously. I pointed out that these changes also enhance providers' role in this process. Without their involvement, she says, the integrated care models that the government is promoting will not work. "Providers are no longer an afterthought," she said.
But all of us know that Medicare doesn't cover the majority of LTC expenses. With the fate of the Community Living Assistance Services and Supports Act unclear, the panelists discussed ways to address the LTC financing crisis. According to Joshua Weiner, the director of RTI International’s Program on Aging, Disability, and Long-Term Care, long-term care costs only make up 1% to 2% of America's gross domestic product (GDP).
Even with a rapidly aging population, LTC costs will be only 2% to 3% by 2040. What the CLASS Act could do is bring more revenue into the field, but if the program is not implemented, it's important that other ways are identified to do so. That may include policy changes to redistribute Medicare funding into long-term care or develop programs that bring Medicaid and Medicare funding together more effectively.
I offered Cathedral Square, a LeadingAge member in Vermont, as an example of bringing together funding streams from state Medicaid programs, Section 202 affordable housing funding and Medicare to create a care coordination program that reduces costs while encouraging older adults to remain independent and at home. Again, she emphasized that this happens because providers are at the table when health policy decisions are made.
Finances aside, what's at the center of LTC's fate in this era are the people who work in the field. From geriatricians to direct care workers, the panelists agreed that the size and scope of the long-term care workforce is in dire straits. They referred to the Institute of Medicine's 2008 report, Retooling for an Aging America, to which I contributed, as a resource for program and policy ideas to educate and empower a workforce that will meet the needs of our aging population.