On December 18, 2013, the Senate Special Committee on Aging held a hearing entitled “The Future of Long-Term Care Policy: Continuing the Conversation.” The hearing was attended by a handful of Senators: Chairman Bill Nelson (D-FL), Ranking Member Susan Collins (R-ME), Sheldon Whitehouse (D-RI), Jon Manchin (D-WV), Tammy Baldwin (D-WI), Elizabeth Warren (D-MA), Kelly Ayotte (R-NH), and Tim Scott (R-SC). The four witnesses during the hearing were:
- Judy Feder, Professor, Georgetown University McCourt School of Public Policy and Fellow, Urban Institute;
- Mark J. Warshawsky, Visiting Adjunct Scholar, American Enterprise Institute (former Chair of LTC Commission);
- Bruce Chernof, President and Chief Executive Officer, The SCAN Foundation (former Vice Chair of LTC Commission); and
- Anne Tumlinson, Senior Vice President, Avalere Health.
The Senators and witnesses agreed that long-term care, whether received in an individual’s home or in a nursing home, is an area that is growing in terms of individuals needing care but remains sorely underfunded and misunderstood. The general public is unaware of the lack of coverage for long-term care offered by health insurance, Medicare and Medicaid. How to successfully address the funding issue is where the Senators and panelists differed in their views. Senator Scott agreed with Mr. Warshawsky, opining that the private sector holds the answers and the possibility of market-based incentives would cause individuals to seek long-term care coverage. Senators Baldwin, Warren, and Whitehouse took greater interest in the idea of a public social insurance mechanism put forth by Judy Feder. Anne Tumlinson made the point that, regardless of a public, private or hybrid financing model, there needs to be some type of mandate in order to create a risk pool large enough to be sustainable. While the Committee reached no conclusions on the topic of how to fund long term care needs, the importance of working to develop solutions was very clear to all of the Senators.
During the question and answer session, Senator Collins brought up the homebound requirement. She noted that the requirement is outdated and forces institutionalization for patients who would prefer to receive care in their homes. Senator Collins questioned whether the requirements for the home health benefit should be changed to remove the functionality requirement that a patient be homebound. Dr. Chernoff agreed that the requirement should be revisited but must be balanced against inappropriately driving up utilization. HCAF agrees with and applauds Senator Collins for her understanding of the homebound requirement and its detriment to patients who prefer to receive care in their home.
As the baby boomers age, the need for quality home care will continue to grow. How to fund home care, and all types of long-term care, is a topic that cannot be avoided any longer. We must work to develop useful solutions that will provide financing for home care now and well into the future. No person should be forced into poverty in order to receive care or into a care situation that does not suit their wishes. HCAF appreciates the attention the Senate Special Committee on Aging has given to long term care needs and stands ready to assist in working toward a solution that protects our nation’s most valuable and vulnerable citizens.