Where is the love?

Lists? I see lists all the time—top 10s, top 3s and what have you. But one crossed my desk recently that really got my attention: the AARP list of top six priorities for healthcare reform. When any organization 40 million strong says it has priorities, you pay attention—especially if it’s in the area of healthcare for seniors, which for us is a no-brainer. I eagerly perused the list, looking particularly for some reference to propping up the shaky financial underpinnings of facility-based long-term care.

Nothing. There was a call for upgraded Medicaid financed home- and community-based services—the LTC wave of the future—and, of course, support for improved Medicare Part D, generic biologic drugs, post-hospital home care, and (top priority) improved coverage for the 50 to 64-year-old age group, especially the unemployed. No surprises—except nothing about financing skilled nursing care or more intensified assisted living, including Alzheimer’s.

But why should AARP be any different? This is the approach most DC policy wonks and politicians are taking on thinking of healthcare reform. Now, I’m not blind—I do know that facility care commands the lion’s share of public financing for long-term care and has for some time. There’s a reason for that: caring for frail, dependent residents 24/7/365 is expensive. It would be nice to think, as apparently many do, that much of this is unnecessary and could be handled in more independent, home-based settings. Last I looked, though, people were still becoming old, frail, and disabled every day and having to leave their homes out of sheer necessity. Their care has to be supported somehow.

By the way, is it too much to ask to have our for-profit and not-for-profit LTC provider organizations—the American Health Care Association and the American Association of Homes and Services for the Aging, respectively—try to negotiate their way to a common stance on LTC financing reform? Their very distinctive, in fact opposing, “private” vs. “government” financing emphases weaken the impact of the facility financing argument on DC policy wonks and politicos.

Of course, I personally have no worries on this score—I know I’ll be staying in my home forever, no matter what, because I am exceptional, don’t you know.

Well, come to think of it, maybe not that exceptional, if AARP has its way.

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