Medicare Compliance & Reimbursement

Leaders speak out with aggressive propositions on LTC reform

Ready or not, over the next 10 years, the aging baby boom population will transform the long-term care system. But will the struggling LTC system be able to ready itself--and repair itself--in time?

Most elderly Americans consider health care an entitlement, studies show. Nevertheless, "most Americans are in denial about the reality that they might live long enough to require some form of long-term care that will make them dependent on people outside of their immediate family," claims the National Institute of Health Policy's David Durenberger. "Most Americans mistakenly think Medicare covers their long-term care needs. Or they just don't want to think about the problem at all," he adds.

Industry leaders are worried, to say the least. In spite of LTC's small successes over the past few years, leaders concur that the system needs massive reform to support the millions of baby boomers who expect adequate coverage in home-based and assisted living settings. "Today, only those who need high-level care around the clock--and don't have family members to care for them--are likely to be placed in skilled nursing facilities," points out John F. Derr, American Health Care Association executive vice president. Inadequate Funding And Quality Measures Top Laundry List Of Problems

Health care leaders have called the current LTC system everything from "flawed" to "broken," citing an abundance of growing problems that demand ambitious and inventive solutions. Durenberger calls Medicaid "a tennis ball hit back and forth in the political responsibility court ... when it comes to setting public priorities, prescription drugs for Medicare beneficiaries, health information technology, and funding for education for health professionals come first--and long-term care finishes last." One of LTC's greatest threats is yet to come. The baby boom generation is fast approaching retirement age--when it hits it will tax the LTC system greatly, leaders fear.

Among LTC's most challenging hurdles is its growing price tag and diminishing funding, leaders agree. "Our current health care system drives many older Americans toward poverty, just as their need is greatest," notes Edward C. King, executive director for the National Senior Citizens Law Center. Costly nursing home care, lacking LTC insurance, limited Medicare LTC coverage and selective private coverage options make it increasingly difficult for the elderly population to afford quality care. Even individuals who consider themselves financially sound in their 60s eventually find themselves reliant on Medicaid, King points out.

Escalating health care costs threaten to put quality-of-care on the chopping block. Baby boomers will certainly demand a level of quality that's above and beyond the level that program funding currently affords LTC programs, notes Derr. Individual LTC insurance from private carriers could improve quality, but insufficient enrollment has caused most private insurers to [...]