A divided congressional long-term care commission has adopted a package of recommendations aimed at improving the nation’s long-term supports and services. However, while a majority of the panel agreed on some modest delivery and workforce reforms, it could not reach a consensus on all-important financing solutions.
In effect, the commission will recommend changes that would effectively retain the current framework of financing and delivering supports and services. Not surprisingly, it was unable to agree on the fundamental restructuring of the nation’s supports and services system that many believe is necessary.
The group divided 9-6 on whether to adopt the report at all. Most commissioners opposing the recommendations were liberals and consumer advocates, though they were joined by Christopher Jacobs of the conservative Heritage Foundation. Progressives did not disagree with most delivery recommendations though they found them timid. They strongly objected to the commission’s failure to tackle the difficult issues of financing.
The panel says its full report will be released on Sept. 18, but the group, chaired by Bruce Chernof of the SCAN Foundation, issued a summary of its recommendations this morning. The report was approved yesterday by Chernof, vice chair Mark Warshawsky, and commissioners Javaid Anwar, Judith Brachman, Stephen Guillard, Neil Pruitt, Carol Raphael, Grace-Marie Turner, and George Vradenberg.
A minority report will be issued at the same time as the majority recommendations.
Sources say there was never much chance the commission–operating with limited resources, deep partisan divisions, and a painfully short time-frame—could tackle the controversial financing issue. Instead, the report will do little more than identify the two prime alternatives—expanding private savings and insurance options or a creating a public social insurance program– without endorsing either.
Five of the minority members—Judy Feder, Judith Stein, Laphonza Butler, Henry Claypool, and Lynnae Ruttledge—called for a new public social insurance program. “We are convinced that no real improvements to the current insufficient, disjointed array of LTSS and financing can be expected without committing significant resources, instituting federal requirements, and developing social insurance financing,” the group said.
The majority report will make some suggestions for improving Medicaid, including a demonstration project that would make it possible for workers with disabilities to continue to get the supports and services they need to remain employed.
It also will suggest making Medicare more accessible by eliminating the requirement that a person must be admitted to a hospital for three days before Medicare pays for post-acute services in a skilled nursing facility. It also urges that Congress “reconsider” the requirement that people must be “homebound” before becoming eligible for home care services under Medicare.
The group’s suggested delivery reforms will include some modest but important proposals. For instance, the panel will call for better integrating supports and services with medical care, improving consumer access to care services, building care teams, and making better use of technology. It also will urge improving access to information and help for family caregivers.
It urged a greater focus on quality across all care settings, especially home and community based care.
The commission will also recommend better training for direct care workers and state standards for home care workers.
Many of these ideas are broadly supported by LTC experts and none are new. However, even with its limitations, getting a congressional commission behind those suggestions could be a useful step toward enacting some of these changes.
The group could not agree on more far-reaching recommendations. For instance, while the report will say that people should live in “appropriate care settings of their choice” the summary did not directly call for ending Medicaid’s structural tilt toward institutional care. Similarly, the summary did not directly acknowledge the need to pay direct care workers more or improve their benefits, two steps advocates have urged for years.
At the same time, while the commission will recommend some more uniform standards for Medicaid, it will not urge that supports and services be federalized or that states be given broader flexibility to provide supports and services without federal waivers.
Congress created the commission last January but all its members were not named until March and it had to complete its work by Sept. 12. Commissioners were appointed by the Democratic and Republican leaders of the House and Senate and President Obama.
The law creating the panel includes no requirement that Congress vote on the commission recommendations. Acknowledging its limitations, the panel will make two more suggestions in its September 30 report: It will ask Congress to create a national advisory commission to complete its unfinished business and it will ask the President to address these issues through a White House conference on aging.
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