Reforming America's Long-Term Care System

Everyone knows at least one person who needs help to carry out the basic tasks of life. Many of us are the people providing those services to a loved one or family member. The long-term care consumers we know best are our own mothers, fathers, aunts and uncles: people who enjoyed full independence until a stroke, hip fracture, the onset of dementia, or some other unfortunate result of the aging process compromised their health.

Two-thirds of long-term care consumers are 65 years or older, a sobering statistic for the oldest members of the Baby Boomer generation, who will reach this age in a matter of years. The number of Americans aged 60 and older will grow rapidly with each passing decade--and they will live longer than all previous generations, thanks to medical and scientific advancements. Unless our nation takes immediate action, we won't be ready to meet the needs of these older Americans--and many of them will suffer as a result.

A perfect storm of events--some good (longer life spans and a growing elderly population) and some bad (increasing costs of care)--will lead to a national crisis, if ignored. Policy makers around the country must acknowledge that our long-term care system is severely strained.

Healthcare has been a much-discussed issue in the 2008 presidential campaign, yet long-term care has been glaringly absent from the discussion. Long-term care is an important piece of the larger health care debate--arguably, the most urgent piece. All stakeholders--individuals, families, caregivers, elected officials--confront a frightening reality as the demand for quality long-term care surges.

Family members face many challenges when an older relative requires long-term care services: the resources of long-term care providers are stretched thin, and government agencies charged with measuring and ensuring the quality of long-term care services are understaffed. We will soon face an unprecedented demand for high-quality long-term care services in private homes, assisted-living facilities, and nursing homes. Under these constraints, the current long-term care system is likely to collapse. Fortunately, we know that reform is within reach.

Some of the most knowledgeable long-term care experts in the country have created a roadmap for a comprehensive national solution to the crisis. They are members of the National Commission for Quality Long-Term Care, which we co-chair. The independent, bipartisan commission, founded in 2004, includes members of Congress, governors, healthcare leaders, and opinion influencers from across the United States.

Mindful of the problems in the nation's long-term care system, the Commission has created a powerful framework for reform. Our goal is to create a future in which older consumers and their families will use long-term care services not with a sense of dread and foreboding, but with sincere confidence and gratitude that when they most need help, high-quality care in a supportive environment will be available to them.

Over the past few years, the Commission has examined the policies and practices that have allowed--indeed, actively encouraged--long-term care providers to design and implement high-quality services. If you read our final report, released today, one thing is perfectly clear: we need multi-faceted change. Long-term care, at its best, focuses on the entire person and takes an integrated approach to that person's care.

Efforts to reform long-term care require an equally integrated approach. So we offer recommendations on quality, workforce, technology, and guiding financial principles that should be taken together. To improve our long-term system, we need to do the following: put the preferences of consumers at the heart of every care setting; provide adequate supports for families caring for people with disabilities; ensure that long-term care workers receive training, compensation and respect; adopt emerging technologies; and institute a financing system where responsibility is shared among government, individuals and the private sector.

With the release of our final report, we are asking care providers, policymakers, researchers, advocates, and especially the 2008 presidential candidates, to develop and champion a national strategy that will enable our long-term care system to serve our aging population better. In a letter to all presidential candidates, our commissioners called for vigorous debate and urged immediate action to forestall this crisis and bring relief and hope to all Americans who are concerned about caring for their loved ones.

We know voters are with us. Most have personal experience with long-term care. A nationwide survey we recently conducted reveals that 94% of voters feel that reforming the long-term care system is important, with 69% believing that this issue has gone largely unaddressed by the presidential candidates.

The issue cuts across party lines, with majorities of Democrats, Independents, and Republicans agreeing that as a nation we have an obligation to provide quality long-term care services to the elderly. This is not a partisan problem and it will require a bipartisan solution. At a time when so many Americans worry about the perils of partisanship, such broad agreement is a bracing reminder that politics should focus on what we share, not on what divides us.

Bob Kerrey, a Democrat, is a former U.S. Senator from Nebraska and current President of The New School, a university in New York City. Newt Gingrich, a Republican, is former Speaker of the House and founder of the Center for Health Transformation. They co-chair the National Commission for Quality Long-Term Care.

Comments

[SmackwaterJack]

With Newt Gingrich in it...

It has to be bad!

[tangerinesong]

Messer"s Kerrey and Gingrich:

Thank you both for your eloquent synopsis concerning long term healthcare for Americans.

As you can see, any individual with a computer and the ability to decipher the alphabet fancy themselves as the "final say" experts on just about everything including being smarter than you both combined on this issue as a majority of these posts attest.

Your gallant attempts to illustrate how bipartisan efforts can produce results have been summarily dismissed by these same experts. There will be no bipartisan agreement on the color of white bread let alone healthcare at this late date. And as such these same experts constantly attempt to cram their "final say" message down the throats of the 80 million Americans that didn"t vote in the last general election which isn't going so well.

I can see clearly now how Mr. Bush stole both elections, LOL because these same experts were on duty at the time.

I have just disgorged my Democratic registration to that of Independent. I was exhausted in trying to wash this expert stink out of my hair five times a day to no avail and I could not be happier for it.

I want to thank you both for your effort here. Well thought out and nicely delivered.

The General should be most interesting indeed.

Tina Ferrer"

[Citizen54]

If Gingrich is for something, it cannot be good for most Americans. We don't need financing schemes, we don't need "bipartisan" commissions. We need federally funded (tax-supported), nonprofit healthcare--which includes long-term care--for every single American.
Every person in America deserves the same healthcare program that our so-called representatives have access to.

Replace the government in 08!

[realitytrumpsbull]

I think Dennis Leary had some good things to
say about this, frankly a good chunk of what
we call healthscare is a Jobs Program. That's
right, Big Cash for passing out sugar pills
and 'there, there's. No, REALLY REALLY REALLY
Big Cash. Like, a whole bunch of money,
and stuff. No, really a lot. Like national debt
'a lot'. All for...infantilizing people, selling
happy pills and writing the Mother Of All
Bullshit Stories on a long list of subjects?
Health insurance, life insurance, car insurance,
home insurance, racket after racket after
racket. Reform means going pork-free. Tune
up and clean up healthscare in america
by making it LESS of a business, and MORE
of a public service. Less is more, get it?
And, have a national debate on end-of-life.
More honesty, less with the sugar pills...

[FogBelter]

Gentlemen, the answer for Long-Term Care is the same as the answer for Healthcare in the United States in general ... The United States needs Socialized Medicine.

Medical Care in the United States has to move from for profit venture to utility.

There are other countries on Earth where Socialized Medicine works and it needs to be implemented here.

Anyone who believes that status quo in US Healthcare is sustainable is kidding themselves ... the system as it stands WILL crash ... not if, but when.

Being adverse to one political ideology or another is acceptable in the US, but not to engage common sense on this massive Healthcare problem is like assuming that an aspirin will cure a case of gangrene ... it simply won't work.

Bi-partisan committees and deep discussion is wonderful but we need ACTION.

Gentleman, there are over 300 million people in this Nation with their backs against the wall regarding Healthcare as it stands ... change is required.

We all appreciate your efforts ... but enough talk ... ACTION!!

Thank you Gentlemen.

[drricklippin]

Strange bedfellows indeed!. Bob Kerry -watch you wallet - watch your soul!!

The key to long term care is US citizens having the maturity to come to grips with death and dying.

The huge "elephant sitting in the middle of health care room" is how to reduce runaway costs which threaten our entire economy-especially what GAO head David Walker calls the economic tsunami of 77 million boomers hitting Medicare.

Reducing costs however is very dangerously close to denying "treatment" so politicians are very circumspect when talking about it. They also avoid the nasty but inevitable "R" word or rationing.

As for me, I believe both individual(health behaviors)and institutional(public health) prevention is our only way out of this fiscal crisis.

Prevention must be implemented incrementally and always with compassion. This applies to long term care as well.

Dr. Rick Lippin
http://medicalcrises.blogspot.com

[dsol]

Having just put my 88-year-old mother-in-law in an assisted living facility (blessedly caring and conveniently located) after four emergency hospital admissions and a desperate search for a facility that was acceptable, affordable, and available, I applaud your bipartisan initiative. The future is upon us -- and it IS us, just a few years or decades down the pike. Unlike many in previous generations, we baby boomers will not go gently into nursing homes that are factory-like at best and all too often filthy and abusive. But unless we act now there may be no other choice when our time comes.

[research]

Newt is a fanatical GOP operative. do anything it takes to win" Newt is a terrorist.

Bob Kerry: This is what happens when you try to be BiPartisan with the rethugs. This is the GOP agenda.

Medicare For ALL!

Kucinich!

[Synoia]

Before discussing solutions, can you point to an accounting of where the money is spent? And then can we compare this accounting with France, Canada, Britain, germany and determine the large differences, the gaps?

To fix any system, requires a Gap analysis of the problem. Focus on the gaps, fix the largest and move to the next.

So please, publish the gap analaysis.

[Bocababs]

To Newt and Bob....

ANYTIME there is a Bi-Partisan take on ANYTHING in this country, I will read it and soak it in. Thank you, both of you...for at least meeting somewhere on common ground. I will be among the aging population in 10 years or so, so addressing this issue is very comforting to me.

[jdm58]

Even if EVERY American had sufficient health insurance to cover an illness, without longterm disability to cover expenses during a major illness they would still be unprotected from bankruptcy due to loss of income. To have a meaningful dialog on Healthcare, revamping the existing Social Security laws on disability must also be brought to the table. Something that is missing from every candidates package, presumably because Al Gore and Michael Moore didn't cover it in their movies, so they don't feel it is necessary.

[colleen2]

Because we are ruled by republicans and centrist Democrats I dread the notion of the current 'leadership' or their advisors doing anything to 'improve' the current dysfunctional and greedy healthcare delivery system. The politicians and their advisors enable and encourage a heathcare system which makes enormous profits by denying necessary care to sick people. Every 'improvement' the pols have made in the past 20 years have made it worse.

[csavage]

To not address ethical considerations prior to discussing funding dooms this argument to failure as well. We, as a nation, need to decide certain issues like, should a 90 year old Alzheimer's patient be offered dialysis as a therapy? Should an 85 year old be offered a coronary bypass? Should a woman with heart disease be offered mammograms for screening for breast cancer after she's 75? Any long term solution to any aspect of our healthcare industry needs to look at cost and needless suffering. Doctors have long known that an elderly patient uses more healthcare dollars in the last 2 weeks of life than his or her entire life prior to the onset of the last illness. Costs of acute care directly impact dollars available for long term care. No aspect of the healthcare industry can be teased out and looked at without fixing the system as a whole