Blowing in the wind

When we children of the '60s heard Bob Dylan croaking that "the answer is blowin' in the wind," many of us dared to believe it was true, that a profound and healthy change was coming to America because the times, don't you know, they were a-changin'. If we had known what really was "blowin' in the wind," we might have thought twice (because it wasn't all right).

As it turned out, "Blowin' in the Wind" was just a song, after all.

Now, though, there's a sense that some powerful breezes really are stirring things up in long-term care. While providers in the field and their customers have seen the changes coming for a long time, when it came to Washington, D.C.'s sleepwalking powers that be, long-term care was a field pretty much to ignore or, at best, subject to legislation that was carelessly harmful. The latest example: the Deficit Reduction Act of 2005 (DRA), going into effect in January. Well meaning as it is in attempting to reduce shameless gaming of Medicaid by the wealthy, it brings with it a host of operational burdens and new financial risks for already hard-pressed providers. (You'll see more on the DRA in subsequent issues.) Another example: the recent Medicaid rules for documenting eligibility-yet another unfunded and not particularly helpful mandate.

The jury is still out on Medicare Part D, although I can well imagine providers holding their breath as a new enrollment season rolls around. And then there's the Bush administration's famous indifference to aging-related policy other than privatization of Social Security and some small (albeit promising) experiments with "money follows the person."

The administration did do something this September, though, that conjured up true winds of change. It released the final report on the December 2005 White House Conference on Aging. You may recall that the conference was a controversial and, some thought, futile event, highlighted by the President's failure even to show up for it. Looked at another way, though, there was something profoundly significant about the event, if you follow the argument in this month's issue by long-term care administrator/writer James A. Lomastro, PhD ("The White House Conference on Aging: A Positive View").

But that isn't all. Occurring within roughly the same time frame was: (1) the founding of a House of Representatives caucus dedicated solely to hashing out issues of long-term care; (2) the appointment of a full-time executive director-the experienced and highly respected Douglas Pace-for the Newt Gingrich/Bob Kerrey National Commission for Quality Long-Term Care; and (3) concluding efforts by the federal Medicaid reform commission as it moves toward its long-awaited December report.

Taking these one at a time, none is, in and of itself, earthshaking. But together they're creating a stirring, a wafting away of clouds of indifference, a soft keening of winds to come. Long-term care is emerging as a substantial focus of national attention.

And all signs are that it's more than just a song. Poet William Butler Yeats may have said it best: "And what rough beast, its hour come round at last/Slouches toward Bethlehem to be born?"
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