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Business as usual

October 1, 2008
by Robert H. Binstock, PhD
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No substantive changes seen in LTC with new president

Next month, a new president will be voted into office. With both Senators Barack Obama and John McCain espousing change, will the new occupant in the White House bring much-needed change in the long-term care industry? Long-Term Living asked a leading expert in aging, Robert Binstock, PhD, of Case Western Reserve University, Cleveland, Ohio, for his thoughts on what a new president might mean to the future of long-term care. Executive Editor Maureen Hrehocik spent an afternoon with Dr. Binstock talking about the prospects for long-term care.

Hrehocik: What are the prospects for long-term care in this election year?

Dr. Binstock: I don't see many prospects for long-term care being a serious issue in this election. There's no indication from either candidate at this point that they have any interest in the issue of long-term care. There are so many other issues that seem very pressing to the American public in general, such as how to deal with the operation in Iraq, the economy, jobs, and even in the so-called “value issues.” That, in itself, tells me that long-term care won't be a serious issue. Even taking a longer term perspective, it hasn't been a serious issue on the public policy agenda since it was part of President Clinton's healthcare reform proposal. Of course, long-term care is on the public agenda with respect to federal and state concerns about the growing cost of Medicaid. In that sense, it's on the agenda in a very negative fashion.

Hrehocik: Have the elderly become a political force?

Dr. Binstock: The elderly, as voters, haven't really been a political force at all. Older people distribute their votes among candidates at about the same proportions as all age groups, except for the very youngest age group which doesn't have its partisan attachments yet. “The elderly” is a very heterogeneous group of people; by social class, economic status, race, and priorities they give various issues. The elderly are not a political movement. AARP has gotten far more active in recent years as a “representative” of the elderly. But it's not particularly pushing anything in a major way regarding long-term care. It's only talking in generalities about healthcare reform. It's just saying this is something that needs to be done. It's very vague. No one has a good handle on it.

Hrehocik: Does anyone or any group have a handle on it?

Dr. Binstock: There are a number of organizations that care about these issues, but they don't have substantial power. I think the greatest potential for a strong political movement lies with the families of those who need care—relatives who are providing care, and who have loved ones in residential facilities. I can see them becoming a real political force because they have a lot more in common than the elderly do. Of course, what they have in common is the relative's need for long-term care and, in the case of caregivers, the physical, psychological, social, and economic burdens of providing care. It's been striking to me when I give various talks around the country, how much the issue of long-term care really resonates among lay audiences. I spoke at the National Health Policy Forum early this summer in Washington. This was a panel with three of us giving presentations about all sorts of things regarding the elderly. We had an extensive discussion at the end of the session and it turned out that everyone in the audience wanted to talk about the issues of caregiving and long-term care. The moderator kept trying to get them to move along to other issues and she couldn't do it! The audience was people who worked for various agencies in the federal government, Census Bureau, CMS, Capitol Hill staffers, all of whom had interest in the other topics we talked about, but what they wanted to talk about most was long-term care. So it seems to me, that's where the potential to improve all sorts of things relating to long-term care lies. The growing potential is also exemplified with more and more media attention to these issues. Recently, the New York Times had a front-page story that was all about respite care. It was very well done and extensive and thoughtful. It concerned how caregivers should really become more aware of respite care and what it could do for them. It indicated more and more nursing homes that don't have respite care beds, are recognizing that they might very well designate some of their beds for that purpose, which I thought was an interesting development. I think the media are paying more and more attention to these issues and writing them up very well.

Hrehocik: Is there any movement in the direction of families becoming the political force championing long-term care?