Long-Term Care’s Lawmakers

It has long been politically fashionable to bash nursing homes and long-term care-especially before an election. Candidates vying for office often adopt a “get tough with nursing homes” attitude to score points with voters. While moralistic posturing makes for good sound bites, it does nothing to address the field’s profound problems with reimbursement and regulation. Fortunately, there are exceptions, even on Capitol Hill.

Nursing Homes/Long Term Care Management recently asked the American Association of Homes and Services for the Aging (AAHSA), the American Health Care Association (AHCA) and the Assisted Living Federation of America (ALFA) to point to federal lawmakers they believe are advancing the cause, not hindering it. Five legislators, in particular, emerged with positive responses from AHCA and AAHSA, although there were more (See “Honorary Mentions”). Also, the highly experienced and ever-articulate Paul R. Willging, PhD, ALFA president and CEO, discusses the “friends” of assisted living in the accompanying sidebar.

Sen. John Breaux (D-La.)
Michael Hogan, Director of Legislative Affairs, AHCA: “Since taking over as chairman of the Senate Special Committee on Aging in 2001, Sen. Breaux has not skipped a beat in carrying forward the mantle of advocating for nursing home residents. He has held several hearings on abuse prevention and elderly protection across settings and at home. He has had his eye on the demographics, and works diligently to develop a long-term care system that is effective for seniors in advance of the baby-boom retirement wave… Breaux is famous for his moderate, ‘get the job done’ approach to legislating that leaves partisan politics out of the equation…. He is a staunch advocate for increased staffing, and he knows that more nursing homes need help and resources than need punishment.”

William Bruno, Director of Congressional Affairs, AAHSA: “Sen. Breaux’s leadership on long-term care issues is and will continue to be invaluable in reforming our long-term care financing system and preparing it for the rest of the 21st century. His ability to foster bipartisan compromise, his deep knowledge of these complex issues and his commitment of time and energy have been deeply appreciated. Most recently, his support for ‘Quality First: A Covenant for Healthy, Affordable and Ethical Long Term Care’ has helped give this important initiative a strong start.”

For more information on Sen. Breaux, visit https://breaux.senate.gov

Rep. Dave Camp (R-Mich.)
Hogan: “Congressman Camp serves on the House Ways and Means Committee-the committee in charge of Medicare. Congressman Camp is the sponsor of H.R. 4030, the Medicare and Medicaid Nursing Facility Quality Improvement Act of 2002. This legislation would correct problems in the nursing facility oversight system that impede quality improvement. Camp has also been active in support of the tax deductibility of long-term care insurance, Medicare payment for dialysis service, the House prescription drug task force and many other proposals to help the elderly and disabled we serve.”

Bruno: “Rep. Camp has been a true champion of quality long-term care for America’s seniors. His legislation, H.R. 4030, will help foster innovative care practices and make it easier for front-line caregivers to provide quality care to residents, and it will also cut through much of the bureaucratic red tape that is so demoralizing for professionals in this field and so counterproductive to serving residents.”

For more information on Rep. Camp, visit www.house.gov/camp

Sen. Tom Harkin (D-lowa)
Hogan: “Sen. Harkin, as chairman of the Appropriations Subcommittee on Labor, HHS and Education, is responsible for setting funding levels for such things as medical research, provider over-sight and the just-passed Nurse Reinvestment Act to address the staffing short-age. Harkin also serves on the Health, Education, Labor and Pensions (HELP) Committee, which has jurisdiction over health professions and many other issues. Harkin is the father of the Americans with Disabilities Act (ADA) and has been a leader in the fight to ensure appropriate services for the elderly and disabled.”

Bruno: “Sen. Harkin was instrumental in getting a 9% increase in funding for Older Americans Act programs in fiscal year 2002. He also added provisions to that spending bill for an Interagency Task Force on Aging Programs, to better coordinate the services that federal and state governments provide to seniors.”

For more information on Sen. Harkin, visit https://harkin.senate.gov

Sen. Tim Hutchinson (R-ark.)
Hogan: “Sen. Hutchinson has in the past two years written more creative legislation to address the key problems of senior citizens than most legislators do in a career. Hutchinson was one of the prime authors of the just-signed Nurse Reinvestment Act. He is the author of the Elder Fall Prevention Act (S. 1922) and of legislation to provide more graduate medical education funding to address the critical shortage of geriatricians (S. 1362). He has supported the Senate version of the long-term care insurance tax-deductibility legislation (S. 627) and has been very engaged in the debate over the adequacy of state Medicaid rates for nursing home care.”

Bruno: “Sen. Hutchinson’s legislative efforts to make available high-quality long-term care have been tremendously helpful to millions of older Americans. This year alone he played a key role in increasing federal financial support for Medicaid and in enacting into law legislation that will expand efforts to ease the healthcare staffing crisis. These initiatives will provide critical support for long-term care providers and for America’s seniors.”

For more information on Sen. Hutchinson, visit https://hutchinson.senate.gov

Rep. Nancy Johnson (R-Conn.)
Hogan: “Congresswoman Johnson, chairwoman of the Ways and Means Subcommittee on Health, has a strong record of leadership on seniors’ issues, including serving as prime sponsor of H.R. 831, a bill to allow above-the-line tax deductibility of long-term care insurance premiums. She has been a staunch advocate for solutions to the critical staffing shortage in long-term care and for improvement of the nursing home oversight system. Johnson is currently working on legislation to promote information technology in nursing homes to improve clinical information transfer, reduce paperwork and prevent errors. She is well aware of the dearth of technology use in long-term care and is seeking to remedy it.”

Bruno: “Rep. Johnson has been a great leader on long-term care and seniors’ issues. As chair of the powerful Health Subcommittee, she has been instrumental in making available the financing that is essential for caring for our nation’s seniors. She has also led efforts to expand the affordability of long-term care insurance and to help reduce the paperwork burden that often makes it more difficult for providers to care for residents.”

For more information on Rep. Johnson, visit www.house.gov/nancyjohnson

“Friends” of Assisted Living
by Paul R. Willging, PhD, President and CEO of the Assisted Living Federation of America
While I’m not sure that any industry sector has “friends” (with the possible exception of oil, rifles and tobacco), one might argue that certain legislators, as judged by either personal experience or legislative activity (including relevant committee involvement), reflect at least an understanding of the industry. And, quite frankly, that is about as much as one should expect or hope for in public policy. If our cause is just and our arguments sound, a legislator who approaches the issues with both an open mind and an understanding of the environment is as much as any lobbyist should ask for.

With that caveat in mind, those in the Senate who have demonstrated a level of understanding include Sens. John Breaux (D-La.), Larry Craig (R-Idaho), Ron Wyden (D-Ore.), Tim Hutchinson (R-Ark.), Blanche Lincoln (D-Ark.) and Charles Grassley (R-Iowa). While all have served on the Senate’s Special Committee on Aging (Breaux and Grassley as chairmen, Craig as chairman and currently ranking member), others have shown a personal or professional interest beyond their membership on the committee. Most, for example, have voiced support for the industry’s position in favor of state, as opposed to federal, regulation.

Relatives of both Wyden and Lincoln live in assisted living communities, as does the mother-in-law of another involved senator, Bill Frist (R-Tenn.). Frist, while not a member of the Special Committee on Aging, does serve on the Senate’s HELP Committee, along with Sens. Chris Dodd (D-Conn.) and Hutchinson. Hutchinson, as ranking member, and Dodd also serve on that committee’s aging subcommittee, while Frist’s father cofounded one of the industry’s pre-eminent retirement companies (American Retirement Corporation).

Many of these senators have also engaged in legislative activities that further demonstrate their interest in the issues facing our profession. Hutchinson has sponsored legislation with respect both to the nursing shortage and the prevention of elderly falls. Grassley has supported the tax deductibility of long-term care insurance, and Dodd has sponsored the Assisted Living Tax Credit Act, which would establish an assisted living tax credit program similar to the low-income housing tax credit.

In the House of Representatives, Rep. Bill Pascrell, Jr. (D-N.J.), has shown his support of assisted living in both the circulation of “Dear Colleague” letters and statements in the Congressional Record. Pascrell serves on the House Committee on Small Business. Rep. Peter Deutsch (D-Fla.), serving on the House Committee on Energy and Commerce, sponsored H.R. 3878, a bill to allow assisted living residents to continue receiving SSI benefits. Rep. John LaFalce (D-N.Y.), ranking member of the House Committee on Financial Services, has sponsored housing legislation to increase funding for HUD programs providing affordable assisted living to the elderly. And Rep. Joe Knollenberg (R-Mich.), who is on the House Committee on Appropriations, has supported affordable assisted living demonstrations. NH

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