LTC Commission wins praise for recommendations, but some members say the group failed to complete mission

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Judy Feder
Judy Feder

Long-term care advocates have praised a set of recommendations issued by the Congressional Commission on Long-Term Care, but some commissioners broke ranks, saying the panel did not fulfill its mandate.

In advance of a full report to be published by the end of the month, the commission released a summary of its recommendations after a vote Thursday. The recommendations cover the areas of service delivery, workforce and finance.

The American Health Care Association/National Center for Assisted Living applauded the commission's work, in particular liking recommendations for implementing site-neutral payments and eliminating the three-day hospital stay requirement to qualify for skilled nursing coverage under Medicare.

“The report includes important policy proposals surrounding what happens after a patient receives critical post-acute care,” added AHCA President and CEO Mark Parkinson. “Helping individuals return to their communities in the best functioning level possible after using long term services and supports is a key goal of our profession.”

LeadingAge President and CEO Larry Minnix said “an initial step” should be creating a recommended demonstration project that would provide disability coverage for workers, allowing them to stay on the job while receiving needed long-term services and supports. He also praised the commission for focusing on family caregivers and ways to leverage technology and support direct-care workers.

However, the commission did not reach a consensus on a comprehensive system for financing long-term care. This makes much of the group's work moot, according to commission member Judy Feder, Ph.D., a fellow at the Urban Institute and professor at Georgetown University. Feder and five other commissioners voted against the set of recommendations that the nine other members approved.

“The biggest problem people are having in getting the long-term care they need is a mechanism to pay for it,” Feder told McKnight's. “That's the ballgame. To not address that is not to fulfill the charge of the commission.”

The recommendations approved by the nine commission members include some that are finance-related, but there is not a call for a public financing mechanism specific to long-term care. Five of the dissenting members issued a separate list of recommendations, including the formation of “social insurance core” that, in conjunction with private insurance and personal finances, would allow people to access long-term services and supports.

Judith Stein, executive director of the Center for Medicare Advocacy, was among the dissenters. Like Feder, she stressed that she could only speak for herself, and told McKnight's she could not support the commission's recommendations for “a number of reasons.” Her primary concern is that they “do not offer hope that people who need long-term support and services can expect real help or change any time soon.”

The commission officially convened in June, and a number of commissioners have argued that they did not have enough time to fulfill the mission from Congress, to recommend comprehensive reforms. Observers such as AARP and Jesse Slome, executive director of the American Association for Long-Term Care Insurance, also made this point.

“I acknowledge that it is silly to think that an issue as complex as long-term care financing could be resolved, let alone adequately addressed, in such a short time and in such a heated political climate,” Slome said Friday.

Slome said a call for a new long-term care advisory group is the “biggest recommendation,” and noted that rising interest rates will help support the private long-term care insurance market.

Nancy LeaMond, AARP executive vice president, also said Friday that while the commission made progress, its recommendations were “only one step of a larger dialogue.”

Click here to access the commission's recommendations.