Healthcare reform law lays groundwork for new long-term care system

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Dr. Bruce Chernof
Dr. Bruce Chernof

[Editor's note: The following editorial is reprinted with permission from the LA Times. Also feel free to check out the editorial at http://www.latimes.com/news/opinion/commentary/la-oe-chernof30-2010mar30,0,2890631.story.]

Healthcare reform has made seniors, by and large, uneasy. Older Americans heard the words "cuts" and "Medicare" in the same sentence and were more likely to believe healthcare reform would hurt -- not help -- them. Lost in the maelstrom of misinformation, however, is the reality that the newly passed legislation lays the groundwork for greatly improving the full continuum of healthcare services for seniors, which includes renovating our nation's nonexistent long-term care system.

With high numbers of adults over age 85 and the coming onslaught of aging boomers, creating a platform for meaningful long-term care reform could not have come at a better time.

A Lake Research Partners poll supported by the SCAN Foundation last June found that nearly 80% of adults (age 18 and over) were supportive of healthcare reform if it included improved options for community-based long-term care. This means creating alternatives to nursing home placement, such as day-service programs, home-care aides, meal programs, senior centers and transportation services. Several provisions in the bill address this aim.

First is the creation of a public, voluntary long-term care insurance program known as the Community Living Assistance Services and Supports program -- CLASS for short. Enrolled individuals who have substantial daily needs would be eligible to receive at least $50 a day (after a five-year vesting period) to be used to defray the costs of services such as home care, family caregiver support, adult day-care or residential care. All actively working adults over 18 could enroll, with the purpose of getting the largest risk pool possible.

Second are programs that will help states expand home and community services so that seniors can avoid placement in a nursing home. A program called Community First Choice provides federal matching dollars for such care. Another increases funding for organizations that help seniors and their families navigate the complex web of our current long-term care services.

Third are impoverishment protections that prevent a healthy husband or wife from being forced to spend all of a couple's shared assets in order to get his or her partner access to community-based services care. Before this legislation, that protection was only available if the person who needed care was in a nursing home.

In addition to setting a framework for long-term care reform, the bill takes a number of steps to bolster the Medicare system and to ensure that the Medicare trust fund will not go bankrupt in seven years as predicted by the Centers for Medicare and Medicaid Services last December.

The legislation aims to reduce fraud, abuse and inefficiencies without cutting guaranteed Medicare benefits. It creates incentives to increase coordination of care for seniors with multiple chronic health conditions, which will decrease costly medical errors and unnecessary hospital readmissions. It helps seniors with high drug costs by closing the Medicare prescription drug coverage gap, the so-called doughnut hole.

New technologies will minimize duplicative paperwork and red tape. The legislation also increases payments to primary care physicians, which will keep them in the Medicare business, and in turn help seniors keep their doctors or be able to find new ones.

Workforce shortages exist at all levels of the continuum of care. The healthcare reform bill offers federal grants for enhanced geriatric training for primary care providers and other health professionals as well as direct-care workers, who provide most of the hands-on care to seniors in their homes or in day-care or nursing homes. The goal is a shift toward care that emphasizes the one-on-one relationship between care providers and seniors.

Let's be clear: The healthcare reform bill does not solve our country's long-term care crisis. Politicians do not get to simply check that box off the list of problems. They must do more. This new law does, however, lay a strong foundation for the long-term care system we will all need.

Neither the product nor the process has been perfect. But most good efforts in life are about progress and not perfection. If you're a senior, or caring for a senior, or if you plan to live beyond the age of, say, 65, this bill is a good beginning on transforming our health and long-term care system into one that works for everyone.

Dr. Bruce Chernof is president and chief executive of the SCAN Foundation and former director of the Los Angeles County Department of Health Services.

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