From ACHCA: ‘LTC Treated Like a Stepchild’

Long-term care still isn’t on the table for healthcare reform, even though Washington has riveted more attention on reform since the Clinton Administration’s abortive attempt at it 16 years ago. And yet some Congressmen “get” the importance of long-term care, said David Kyllo, executive director of the National Center for Assisted Living, at a weekend policy panel at the ACHCA Convocation. Kyllo was joined on the panel by Vincent Mor, PhD, well-known Brown University LTC researcher, Angello Rotella, former chair of the American Health Care Association, and Lane Bowen, president of the Health Services Division of Kindred Healthcare. Kyllo observed that, in general, Washington policymakers have always treated LTC “like a stepchild.”

Bowen suggested that perhaps “long-term care” was a misnomer these days, with average length of stay down to 92 days. “Cases have increased in co-morbidity and are harder to stabilize, and case mix has doubled in recent years,” said Bowen. “This is not your Mom’s traditional nursing home.”

Focusing on facilities’ growing post-acute role, the panelists discussed recent proposals that would “bundle” Medicare reimbursement rates as one price covering all hospital and SNF services per episode. Federal policymakers have floated the idea as a way of reducing hospital readmissions and unnecessary hospitalization for Medicare patients. But, according to Dr. Mor, no one knows how to administer this yet and hospitals are lukewarm to the idea. Bowen indicated, however, that bundling is already happening under some managed care plans, with the Kaiser MCO, for example, drastically reducing costs and lengths of stay by involving physicians and other clinical support services more intensively in the SNF than usual. “We should be doing this, and we need this kind of support to get it done,” said Bowen, adding that the Kaiser approach is popular with both employers and patients.

Connecticut administrator Molly Savard asked from the audience, however, whether the panel’s focus on post-acute care wasn’t overlooking the traditional chronic care residents whose lengths of stay are indefinite. “There are some people for whom we can’t reduce length of stay—unless maybe we kill them!”

Dr. Mor noted that even those residents are hospitalized regularly and have the same rehospitalization patterns as post-acute patients.

Randy Lindner MHSA, CAE, president and CEO of the National Association of Boards of Long Term Care Administrator Boards (NAB), chaired the panel. He ended the discussion with a call to ACHCA members to re-emphasize recruitment and retention of young administers whose numbers, he said, have dropped dramatically in recent years.