A new way to think about long-term care funding

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John O'Connor
John O'Connor

During a talk last Monday at the LeadingAge conference, Harvard Professor Jennifer McCrea served up an interesting take on the warping nature of money.

To be more specific, she said that when dollars are at the center of a relationship, it creates a superior/subordinate relationship. The result of course, is that the requester must essentially grovel, while the funding gatekeeper decides whether the groveling is sufficient.

She also offered a way to change that dynamic: Remove money from the center. How can that happen? And how do such notions relate to long-term care?

She offered an answer to the first question; I'll try to tackle the second.

You remove money from the center of a relationship by replacing it with something else that's more significant. One possibly proxy is a greater purpose that resonates with both sides.

To drive home the point, she repeated a quote from Lila Watson, an Aboriginal elder, and activist from Australia:

“If you have come to help me, you are wasting your time. If you have come because your liberation is bound up with mine, then let us work together.”

As for the long-term care tie-in? Let us consider how the field is publicly funded these days. Essentially, providers are told to take a number. Congress decides which causes will get funded, and to what extent, while also determining the requisite amount of hoop jumping.

As a result, the industry constantly finds itself in a position where it must cajole, beg, support, butter up and sometimes even threaten various lawmakers. This is done in the hope that the gatekeepers will either sweeten the funding pot, or at a minimum, limit the damage. To put it in the most charitable way possible, this is an unhealthy relationship. But those are the current rules of the road.

How much better it would be if the relationship was based on a different framework. A framework in which providers and lawmakers actually worked together to create a better reality for residents. Certainly, operators in this field would benefit under such a scenario. And here's the thing: so too would state and federal lawmakers. By focusing first and foremost on working together to improve care delivery (and, oh, by the way, provide reasonable funds for making such improvements possible), they would in a sense be liberating themselves.

No longer would lawmakers merely be accountants in a zero-sum game. They would instead be partners helping to create a better world for their constituents, their parents and maybe even themselves.

And that, my friends, is the problem with listening to professors. It fills one's head with all kinds of crazy ideas.

John O'Connor is McKnight's Editorial Director.

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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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