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Warning Signs for the White House

October 1, 2005
by root
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Is there danger ahead or just a curve in the regulatory road? LTC thoughts for the 2005 White House Conference on Aging

LTC leaders sound off on the forthcoming 2005 White House Conference on Aging It happens every ten years-the presidential administration occupying the White House summons deep thinkers, experienced practitioners, association executives, advocates, and activists of every stripe to assemble in Washington, D.C., to hash out policy for dealing with the aging of America. This has produced eloquent pronouncements, penetrating observations, and reams of research data, all receiving national exposure in unusually concentrated form. No doubt each conference has influenced legislation and policy making during the subsequent decade in hundreds of ways. But no dramatic policy measure or law has yet to emerge from one.

This December the fifth such conference will occur. In terms of inspiring definitive action, will this one be different?

On the plus side is a slowly growing consensus in Washington that the aging of America is truly becoming a front-burner issue. Aside from the fact that the oldest baby boomers, born in 1946, are about to enter their 60s, there is the phenomenon of the boomers' parents requiring long-term care services in rapidly growing numbers. It seems safe to say that everyone "knows someone" having direct contact with long-term care. Each person has a story to tell, and it's often not a happy one. In short, the public imperative for action is almost upon us.

On the negative side is a political system distracted by war, budgetary deficits, strongly competing needs within healthcare and education, and powerful, often bitter, partisanship. This can frustrate good intentions, well-thought-out recommendations, and all but the most powerful of political upswells. Despite the demographic-and increasingly political-imperative, the fifth White House Conference on Aging could conceivably go the moderately influential way of the others.

If so, it won't be for lack of long-term care leaders speaking out. In April, a large cross section of them from all walks of life-providers, planners, insurers, and government and corporate officials-convened for what was billed as a "mini-conference" in preparation for the 2005 White House Conference on Aging. Three workgroups hammered out a set of specific recommendations for what all agreed was a national crisis (see "Recommendations at a Glance"). Subsequent to the release of the mini-conference's recommendations in August, several attendees offered further thoughts as they and others prepare for the official "march on Washington" in December.

Do you believe long-term care faces a crisis? Why or why not?

Carol Regan, Director, Health Care for Health Care Workers Institute, Paraprofessional Healthcare Institute, Bronx, New York: Yes, in many ways, but particularly regarding the workforce, a largely "invisible" issue that policy makers, employers, consumers, and worker advocates are beginning to address. There is a huge "care gap": Between 2000 and 2030, our elderly population (age 65 and older) will more than double, increasing by 104%. In the current decade alone, the U.S. Bureau of Labor Statistics projects that the demand for direct-care workers serving long-term care clients will increase by more than40%-requiring an additional 800,000 direct-care workers.

Less understood is that the growth in the traditional supply of direct-care workers-women aged 25 to 44-will slow dramatically. Between 2000 and 2030, the number of women in this age group will increase by only 7%. In fact, during the current decade, the number of women aged 25 to 44 in the entire civilian workforce will increase by only 400,000 workers.

Stephen McConnell, Senior Vice-President for Advocacy and Public Policy, Alzheimer's Association, Chicago: It is a serious crisis. We have the absence of a coherent financing system, the aging of the baby boomers, demand pressures on Medicaid, worker shortages, and a head-in-the-sand attitude of national leaders.

Todd Smith, Director of Legislative Policy and Analysis, American Health Care Association/National Center for Assisted Living (AHCA/NCAL), Washington, D.C.: Medicaid is in crisis, and this has serious implications for long-term care. Proof is in the rising costs of Medicaid, which pays the bills for two out of three individuals needing nursing facility care. According to a 2005 BDO Seidman study,1 government (state and federal) does not fund the full costs of care, thus:

  • the average shortfall in Medicaid nursing home reimbursement was $12.58 per Medicaid patient day;
  • the daily reimbursement shortfall increased by approximately 9% from 2001 to 2002 (about 39% in the four years from 1999 to 2002); and
  • unreimbursed Medicaid allowable costs were estimated at $4.5 billion nationally.

This situation will only get worse in the future because of our nation's rapidly aging population. Even with steep underpayment for services by Medicaid, several government reports2 have noted that long-term care quality is on the rise-yet these gains will be hard to maintain if shortfalls persist.

How might financing of long-term care be improved?

Regan: To address this workforce crisis, adequate funds need to be invested to guarantee a living wage for the millions of mostly women workers, as well as health benefits, training, and career ladder opportunities.