More on the Long Term Care Commission

We posted previously (August 19th)  about the federal Long Term Care Commission’s upcoming meeting. We are looking at the results of that September 12, 2013 meeting. The full report is coming out September 18th, but the summary and call for action are now available on the Commission’s website.  This is very important information and I hope everyone will read these materials in their entirety as well as the full report, but for now, here is my synopsis.

The summary of the recommendations covers 4 topics: (1) service delivery, (2) workforce, (3) financing and (4) National Advisory Committee on LTSS.    Service delivery has a number of recommendations, broken down by subcategories: rebalancing, integration, uniform assessment, consumer access/assistance, quality and payment reform. The titles for the recommendations tell us a lot, including the use of technology, livable communities, a standard and simplified assessment, streamlined access to services, and new models for payment.

Workforce has 4 recommendations for family caregivers, 2  for paid caregivers and 4 for the direct care caregivers.  I thought the family caregiver recommendations are important, but we have to consider the other reports we have seen on the availability of family caregivers and the “caregiver support ratio” we discussed in an earlier post. It seems to me that the other two categories are looking to emphasis quality of care.

Finance offers a vision (sustainable balance between public and private payment for LTSS)  and 2 alternatives, with 2  recommendations each for Medicaid and Medicare. For Medicaid-they recommend a demonstration project for those individuals with disabilities who can work while still keeping LTSS coverage, and more state uniformity on buy-ins for those individuals. With Medicare, the two recommendations are quite concrete-eliminate the 3 day hospital prerequisite for SNF care and “reconsider” the homebound requirement for receiving home health services. There is also a recommendation under savings to allow individuals with disabilities or families to use money in an educational fund for LTSS. As far as the committee, the recommendations are pretty straightforward-keep a committee to make sure progress occurs and hold a White House Conference on Aging that covers, among other things, LTSS.

There have been some articles regarding the report, including one blog post from Judith Graham in the September 13th  New York Times New Old Age Blog that noted that the Commission “stopped short of endorsing a new public or private program to help families pay for home health care, custodial care, assisted living or nursing home services.” The blog goes on to note a disagreement within the Commission: “[i]n a letter to President Obama and Congressional leaders …  six …  emphasized … that ‘the commission’s recommendations should not increase the existing budgetary commitment to health care faced by both state and federal governments’” and … five …  issued a statement strongly supporting a more robust publicly financed long-term care program.”  The National Council on Aging’s (NCOA) Howard Bedlin, VP of Public Policy & Advocacy issued a statement on September 13, 2013 commenting on the report, with support for some recommendations but expressing disappointment with the absence of unambiguous direction  for LTSS funding.

Becky Morgan

Stetson Law