The BIG picture: Nursing homes are not long-term care's embarrasing relatives

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John O'Connor, Editorial Director
John O'Connor, Editorial Director
I grew up near neighbors who hid their mentally disabled child in the basement whenever company paid a visit.

Had a bit of a flashback last month, when the Senate Special Committee on Aging decided to hold a hearing on future directions for long-term care. This time, the nursing home industry was quickly walked down the stairs.
The invitation seemed welcoming enough. Even promised a conversation on “the inclusion of improvements to long-term care services and supports as part of emerging blueprints for national health reform.”

Thomas Hamilton from the Centers for Medicare & Medicaid Services sort of previewed the Obama administration's programs and priorities for improving the delivery of services to older adults and individuals with disabilities. But it turns out they're still working on a few of the finer points, such as how these will be done.

Karen Timberlake, Wisconsin's secretary of Health and Human Services, talked about the state's “Family Care” program, which includes beefing up home- and community-based services. Not to be outdone, Holly Benson, secretary of Florida's Agency for Health Care Administration, discussed her state's HCBS efforts.

In the afternoon, three others discussed independent living, home- and community-based services, and revamping long-term care.

These are all nice people. They all spoke knowingly and eloquently. But if a stranger happened to wander into the hearing, he might have wondered if he'd missed the discussion on nursing homes, their present role, or why they are not welcome.

Look, I'm all for the expansion of home- and community-based services. I hope they are available for me someday. But if we're going to talk about ways to improve long-term care, maybe we should start with an honest discussion about the facts of life.

Last time I checked, the federal government was spending more than $100 billion a year on nursing home care. We have 15,000 nursing homes in this nation, taking care of more than 1.4 million people each year.

Those would seem to be pretty solid credentials for getting a seat at the big-boy table.

But they are not.

Nursing homes are clearly  on the outs, at least as far as the architects of our nation's future are concerned. Maybe in the long run that's a good thing. But it would be nice if we weren't treated like embarrassing relatives.