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The Year Ahead for Long-Term Care

December 1, 2001
by Suzanne Weiss
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Views from legislative advocates and analysts
Views from legislative advocates and analysts   It's been said that September 11, 2001, changed everything. That's certainly been true for those who are charged with shepherding long-term care legislation through Congress and for those who analyze their campaigns. Suddenly on that date, advocates pushing-with some effectiveness-for government-sponsored initiatives to improve staffing and provide regulatory relief were confronted by a Congress preoccupied with national defense, economic revival and personal safety from anthrax. Major healthcare initiatives such as Medicare prescription drug coverage and a patients' bill of rights withered in the face of a new congressional emphasis on bipartisanship. Yet, for some long-term care issues, hope remained. The problems threatening to cripple long-term care haven't gone away, and the demand by the elderly and disabled for high-quality services continues to grow. It also helps that the Congress that left this year is the same Congress that is returning next year; there is no substitute for familiarity with the issues.

What does this mean for long-term care in 2002? Although predictions are hazardous, especially in this day and age, Nursing Homes/Long Term Care Management asked some key observers of the legislative wars to focus on likely developments in the coming year.

John Schaeffler, Vice-President of Legislative Affairs, American Health Care Association

"It is definitely not business as usual in Washington, D.C.-perhaps especially in Washington. About 95% of Congress's attention was focused on current events this fall, and there's been a 'good taste' issue involved in how far we can push on specific issues. Some of the big, controversial issues like a patients' bill of rights and Medicare prescription drug coverage have been tabled, though, and there are new opportunities for some smaller issues to get attention.

"Right now we're repositioning ourselves on the issues of workforce, Medicaid, Medicare, and survey certification and enforcement. Just a couple of comments on each:

"Workforce. An important initiative is the legislation sponsored by Senator Edward Kennedy (D-Mass.) and Tim Hutchinson (R-Ark.), providing $5,000 training grants for workers displaced by the economy. We know that there are 100,000 positions available in long-term care today, and this could be an excellent opportunity for facilities to strengthen their staffs. We also foresee progress on single-task workers and a federally funded criminal background check system integrating with the various state programs.

"Medicaid. If you look at the $3.3 billion shortfall shown by the Lubarsky study [see "NH News Notes" November 2001, p. 9] and the $3.1 billion that would be needed to meet the 2.75 hours per resident per day staff ratio that's been talked about, that's a $6.4 billion 'ask' for Medicaid. That's huge but appro-priate, based on the data disclosed by Lubarsky. The governors are becoming concerned about Medicaid expenses as they see surpluses vanish and revenues drop, and there's general agreement in the states that the federal government has got to step up on this issue. Meanwhile, we need to partner with the National Governors Association and the Republican and Democratic governors' associations and see if there is some way to link Medicaid with welfare reform. We also need a lot of grass-roots activity by our members in all the states. Eventually there could be a Medicaid swap, with the federal government taking over all long-term care Medicaid and the states handling the rest, and this has realistic prospects in view of the states' budget problems.

"Medicare. The fiscal relief we got for the Medicare PPS sunsets in October, and we're going to be working hard for a one-year extension. We're working with CMS (the Centers for Medicare and Medicaid Services) on marketbasket calculations, but a concern is that if CMS goes through with some of the PPS refinements it's discussed, that would lead to additional reductions that the profession is not prepared to withstand.

"Survey certification and enforcement. One thing is for sure: Any proposal to dismantle the survey system is dead on arrival. We need common-sense reforms, and we have a chance at that with the Medicare Education and Regulatory Fairness Act (MERFA). Although it is not a sure thing, we think there's a chance for progress on expedited appeals for survey violations, and we'll be working hard on that.

"In general, we have to find a way to make long-term care issues generate the same kind of political interest and activity as the patients' bill of rights and Medicare prescription drug coverage did, in order to make progress on the reform we really need."

Suzanne Weiss, Senior Vice-President of Advocacy, and Will Bruno, Director of Congressional Affairs, the American Association of Homes and Services for the Aging

Bruno: "Congress has focused almost exclusively on national security issues, and there's been bipartisan agreement to jettison virtually anything controversial this year. Because congressional focus has changed so much, we've repackaged our agenda. For example, we've always advocated strongly for legislation designed to help recruit and retain nurses and nurse assistants, but now we can also link this issue to the national call for health preparedness. On regulatory reform, we're continuing to push for national policies that offer incentives for high-quality providers and relief from some of the punitive and counterproductive sanctions under current law. More comprehensively, we're hoping that, through waivers, states will be able to demonstrate successful alternatives to the current survey system."