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Public policy leaders have far-reaching effects on long-term care. To help mark our 25th anniversary, McKnight's invited the most influential figures in the United States to give their personal visions and thoughts on the long-term care profession.

There's no quick, easy way to maintain quality care
By Sen. Charles Grassley

Congratulations to you on this milestone. I want to thank McKnight's readers for doing some of society's most emotionally and physically demanding work.
The heavy workload will only increase as American longevity hits records. The challenge for policymakers is how to make quality of care uniformly high with limited patient and taxpayer resources.
On the resident side, I've introduced legislation to help reduce the cost of long-term care insurance with a tax deduction for the policy's cost. The bill also allows individuals living at home or their caregivers a $3,000 tax credit to help cover out-of-pocket long-term care expenses.
On the provider end, in 2003 I received written commitments from nursing home association leaders that $4 billion in additional Medicare payments would go only to direct patient services, not to administrators' salaries or profit margins. Since then, I've received verbal assurances of that pledge. I hope to see improved quality of care as a result.
On a related front, I've introduced legislation to link Medicare payments to quality for the first time. For nursing homes, the bill requires the Centers for Medicare & Medicaid Services to develop appropriate measures to better monitor quality of care, including the link between quality and staffing. It also includes policies that would allow the agency to assess improvement in patient function by collecting information when a patient both enters and leaves a nursing home.
It must be demoralizing to know that if you work your hardest, and help your patients enjoy longer, healthier lives, federal healthcare programs don't measure your good outcomes. I want to change that.
There's no quick fix to maintaining nursing home quality. It demands a sustained effort focused on supporting the hands-on professionals who feed, bathe and otherwise provide quality care for residents.
I'll keep looking for ways to improve nursing home quality and continuing our dialogue on how to make that happen.

Grassley (R-IA) is the chairman of the Senate Finance Committee and a past chairman of the Senate Special Committee on Aging.


Let's place less emphasis on institutional settings
By Mark B. McClellan, M.D., Ph.D.

We all know what we want our healthcare system to deliver: the right care for the right patient every time. Increasingly, we are finding that "high quality" means care that is personalized, prevention-oriented, and patient-centered, based on evidence about the benefits and costs for each particular patient. This is really important today, as we meet the challenge of making sure that Medicare and Medicaid provide high-quality, affordable care to everyone.
And we know that at the heart of this goal is the healthcare worker. Medicare, Medicaid, families and patients all look to you to provide high quality medical services in a caring environment, as both are crucial to the well-being of your patients.
But we face big challenges, particularly in getting Medicare and Medicaid up to date. Benefits for both programs have fallen woefully behind modern medicine, and that is particularly evident in long-term care services. Patients who a decade ago had to be placed in skilled nursing facilities now can be maintained at home with better drug treatments and other therapies that now can be safely delivered outside of the institutional setting.
If we don't take action to bring Medicare and Medicaid benefits more in line with patient desires and medical achievements, we will not be able to sustain the benefit -- especially in the Medicaid program. We need a better approach.
We think that better approach will be to shift our programs' bias away from institutional care and to introduce more home- and community-based care. We know people prefer it, it may be more cost-effective and it will create a new environment in which you can practice. We have some anecdotal evidence that the shift in some communities to mor


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