Monday, April 23, 2012

US Senate holds Hearing on "The Future of Long Term Care"


On April 18th the United States Senate Select Committee on Aging held a hearing on “The Future of Long Term Care: Saving Money by Serving Seniors.” Testimony was presented by: 

John O'Brien, Director of Healthcare and Insurance, Office of Personnel Management, Washington, DC

Loren Colman
, Assistant Commissioner, Minnesota Department of Human Service, St. Paul, MN

Judy Feder
, Professor of Public Policy and Former Dean, Georgetown Public Policy Institute, Georgetown University, Washington, DC

Bruce Chernof
, President and CEO, SCAN Foundation, Long Beach, CA

Douglas Holtz-Eakin
, President, American Action Forum, Washington, DC

Senator Kohl, the Chair of the Committee, asked the panelist to comment on how we can do a better job of providing long term care without spending more. While the panel represented diverse perspectives, I was struck by the relative consensus expressed on a number of approaches:

  • Improve coordination of care across the spectrum of programs delivering long term services and supports – we should expect to seek increased use of managed care to deliver long term care;
  • Do better at rebalancing the setting for care delivery away from bricks and mortar institutions and towards home and community based care;
  • Increase the use of technology through the employment of “Lifeline” type systems that connect care recipients with caregivers and providers. Support through technology can include services such as monitoring of medications and conditions, coordination of care, and identification of the need for interventions, with the result that expensive hospitalizations can be avoided;  
  • Increase support for family caregivers;
  • Provide flexibility to meet the unique individual circumstances and needs of care recipients

Of course, these concepts are not new. And there is a big gap between discussion (and even consensus) of an approach and implementation. But we do need some consensus in Congress (as opposed to gridlock) if we are to ever move forward with any effective responses to the nation’s long term care crisis. 

Note the condition precedent in Senator Kohl’s (a Democrat’s) question - “without costing more” – should not be missed. Committee Ranking Member Senator Corker (a Republican), commented that in today’s dollars an average family puts about $119,000 into Medicare during their lifetimes, while they take out $357,000. The cash flow discrepancy is approaching $300 billion a year. A viable program cannot spend 3 times as much as it takes in. 

My conclusion from these two Senator’s comments – we should expect major entitlement “reform” focused on reducing spending to be part of the resolution of the tax and budgetary cataclysm that is set to occur in Congress at the end of this year.    

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