The White House Conference on Aging (WHCOA) events have a way of sneaking change into the U.S. long-term care (LTC) system in a flood of speechifying.
Administrations have been holding the conferences every 10 years or so since 1961. Obama has scheduled the next conference to take place July 13.
Organizers of the 2015 conference are encouraging members of the public to “get involved” through many activities that sound as if they came out of a Cub Scout or Brownie merit badge guide. Such as: watching the event stream live; sharing personal stories about “why the issues discussed at the conference are important to you”; interviewing an older adult; hosting a watch party; and completing the sentence “Getting older is getting better because…”
Groups with an interest in aging and independent individuals have participated in a series of regional forums leading up to the main event and repeated many of the same kinds of concerns over and over.
Ten years ago, some of the insurance agents and brokers who were watching the 2005 conference may have despaired at the thought of any concrete changes emerging, especially given the hostility between Democrats and Republicans on Capitol Hill. But policymakers there planted the seeds for the Patient Protection and Affordable Care Act (PPACA) provisions encouraging state Medicaid programs to spend LTC money on home and community-based care, not just on nursing home care.
The policymakers there may have also increased policymaker interest in family caregivers and other providers of unpaid care, and in the effort to encourage consumers to buy private long-term care insurance (LTCI) by using state “Partnership” programs to give buyers of qualified LTCI an easier time qualifying for state Medicaid nursing home benefits if they exhaust the private benefits.
This year, the Obama administration goes into the 2015 conference with the U.S. Department of Health and Human Services (HHS) wrestling with the PPACA commercial health insurance programs and running a new LTC policy agency.
See also: HHS creates LTC policy agency
What could come out of this conference?
For a look at some of the ideas circulating in the aging con-o-sphere, read on.
1. Agents and brokers who feel stress when they hear about the Patient Protection and Affordable Care Act (PPACA) may need to take a deep breath before reading conference-related documents.
The WHCOA staff has helped members of the public get involved in discussions about long-term care, which they call long-term services and supports (LTSS), by posting a policy brief on the topic.
The staff mentions PPACA seven times and the achievements of the Obama administration twice.
The staff notes, for example, that, in 2013, the Obama administration “took an important step forward” in helping paid LTC workers, by having the U.S. Department of Labor extend minimum wage and overtime protections to home care workers.
“Direct care workers, like other low-wage workers, are likely to benefit from greater access to health insurance through the Affordable Care Act,” the staff members write.
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2. Some commenters are talking about the need for better LTCI programs, but not necessarily programs that insurers (or even public agencies) could actually create.
“Private options (including long-term care insurance, whole life insurance or life insurance riders, reverse equity mortgages, and annuities) are available to help some people plan ahead for their future care,” the WHCOA staff says in the LTSS brief. “But there is currently no comprehensive long-term care financing program available to all older clients.”
Several members of the public suggest in the comments section under the brief that the government should create new private LTCI incentive programs. Jennifer Dexter of Easter Seals, for example, writes in support of expanding access to private LTCI.
Some, including Allicyn Wilde of the Service Employees International Union (SEIU) and Dr. Cheryl Townsend Winter of the Washington State Council on Aging, call for the government to create a new public LTSS program.
“Create a social insurance LTSS benefit, such as including a LTSS benefit as part of Medicare,” Wilde says.
Townsend Winter says the government should establish mandatory LTSS programs.
But some commenters don’t seem to remember the trouble HHS had with trying to make the voluntary LTC insurance program that was supposed to be created by PPACA sustainable. One knock against the PPACA LTC program was that it was doomed because enrollees could be working-age adults who were already severely disabled enough to qualify for LTC benefits.
One of the commenters on the WHCOA LTSS brief says the government needs to create a “voluntary, national long-term care insurance program” that “does not exclude purchasers based on pre-existing health conditions.”
See also: 5 possible cures for what ails LTCI
3. Professional caregivers need to eat. And pay the rent. And get health care of their own.
Advocates for the people who work in nursing homes and provide home care have pointed out that they are some of the most poorly paid, badly treated in the United States.
They are demanding that the country move to improve those LTC workers’ compensation and working conditions, not try to hold down LTC costs by further tightening the screws on LTC workers.
Caitlyn Connolly writes in a commentary on the National Employment Law Project (NELP) website that providing decent benefits and family-sustaining wages is critical to meeting the country’s rising demand for home care workers, home health aides and personal care attendants.
Connolly cites the example of Kim Thomas, a direct care worker who earns $10 to $11 per hour, works a minimum of 16 hours per day, and never gets overtime pay. “We must improve these working conditions,” Connolly writes.
4. Interest groups want policymakers to think more about the LTC needs of aging members of their groups.
When the designers of state-based PPACA public exchanges were designing their outreach programs, they raised eyebrows with talk about a need for extensive ethnically based outreach campaigns, and efforts to translate materials into languages such as Tagalog and Navajo.
But, when the first PPACA open enrollment period was over, exchange managers reported that some of their most obvious performance gaps involved problems with getting the attention and trust of members of specific groups.
Traditionally, the United States has relied heavily on LTC services provided by nursing homes organized by specific religious and ethnic groups for members of those groups.
This year, many groups have been talking about a need to get national policymakers to think more about the LTC needs of members of specific groups.
The National Indian Council on Aging Inc. (NICOA) reported on the Diverse Elders Coalition blog about a WHCOA listening session in Norman, Okla. NICOA says its executive director, Randella Bluehouse, asked the WHCOA organizers to hold the event after she attended a regional forum in Phoenix and was disappointed by the lack of discussion about aging in Indian country.
Services & Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (SAGE) has been working to get policymakers to find ways to provide culturally competent services and supports and back non-discrimination provisions. SAGE also wants policymakers to require agencies to collect data on gay, lesbian, bisexual and transgender elders. “If we are not counted, we don’t count,” the group says.
Image: TS Image/Diana Ong
5. Many people participating in the preliminary conversations seem to have trouble understanding the concept of limits on resources.
The would-be policy shapers want better public and private insurance programs, better treatment of paid caregivers, more resources for informal caregivers, more attention to quality and many other improvements, and few, if any, of them seem to be jumping to provide the money to pay for those programs.
The players who may be talking most about a concrete way to save money may be the advocates of adult day care services.
Roy Afflerbach talked about community-based day care on the WHCOA LTSS blog, on behalf of the National Adult Day Services Association, which represents organizations that can provide nursing home-level health care services during the day, for about 40 percent of the cost of a stay in a nursing home.
He noted that Medicare does not give adult day health centers the same respect that Medicaid or private insurers do. He is asking for Medicare to allow use of adult day health centers as a community-based alternative to nursing home placement.
Kay Henry and Lois Arsenault also wrote on behalf of adult day health services. “Without vast financial resources and/or a large family whose members are able to provide sufficient support without burnout, ‘aging in place’ is a myth at this time,” Arsenault says, suggesting that adult day centers can save family caregivers from burnout and make keeping older adults in their homes a practical option.