The news for critical long-term care services and supports provided by the states--either through Medicaid or other funding--keeps getting worse. The toxic combination of a still-slow economy, huge structural budget pressures on all levels of government, and growing demands for aging and disability services is leading to ongoing cuts in both critical benefits to individuals and payments to providers. The latest evidence comes from [...]
In the decade between 1999 and 2008, almost 3,000 nursing homes closed while the number of skilled nursing facility beds shrunk by nearly 100,000, or about 5 percent, according to a new study in the Archives of Internal Medicine. In a nation with more nursing homes than McDonald's, and at a time when long-term care can be provided in other settings, that may not be [...]
For the second time, President Obama has bowed to conservative critics and backtracked on a plan to allow Medicare to pay physicians for end of life consultations with their patients. He should be ashamed. In late November, the government adopted new rules that included discussion of advance directives as one of many services physicians could provide during routine annual physicals for their Medicare patients. [...]
The Obama Administration has decided to pay doctors for discussing end of the life issues with their Medicare patients. You may recall that this would have been permitted by the 2010 health law, but the provision was dropped in the face of withering criticism by opponents of health reform, who dubbed these important conversations "death panels." The new rules are an important first step. Doctors absolutely [...]
Last year, the Minnesota Citizen's League asked me to help with a very ambitious project: The group wanted to find ways to improve our broken system of long-term care financing. Earlier this month, the non-profit, non-partisan League came up with its recommendations. I don't agree with them all, but among their far-reaching proposals are some ideas that I hope have legs. The League's white paper, [...]
I'm just back from a two day conference sponsored by the Catholic Health Association on ways we can do a better job integrating both medical and personal care for chronically-ill seniors. There may be no more important issue for the delivery of care to this population. If you don't believe me, ask Don Berwick, who runs the Medicare and Medicaid programs for the federal [...]
Senior Obama Administration official Richard Frank says he is "cautiously optimistic" that the Department of Health and Human Services (HHS) can build a viable government sponsored long-term care insurance program under the CLASS Act. CLASS is a national, voluntary long-term care insurance system that was included in the 2010 health reform law. Frank, a highly respected professor of health policy at Harvard Medical School, is Deputy Assistant [...]
Erskine Bowles and Alan Simpson, the co-chairs of President Obama's deficit reduction commission, have called the CLASS Act "unsustainable" and are proposing that it be either reformed or repealed. They say the national voluntary long-term care insurance program passed as part of this year's health reform law "is viewed by many experts as financially unsound." The first version of the Bowles-Simpson [...]
For seniors trying to manage multiple chronic disease, moving from one care setting to another can literally be a matter of life and death. That's why it is so important that health providers--doctors, nursing homes, hospitals, assisted living facilities, and home care agencies--work together to make sure that those moves happen safely. Too often in our poorly coordinated health and long-term care systems, those [...]
It is a tough time to try to sell long-term care insurance. The private market was stunned on Nov. 11 when MetLife, one of the nation's biggest carriers with insurance on 600,000 lives, announced it would stop selling new policies. At the same time, surveys by two of the nation's most respected long-term care researchers suggest why it will continue to be very [...]