Health-care law has 1st US long-term care plan

April 19, 2010 at 12:00a.m.

McClatchy Newspapers

WASHINGTON

A casual observer of the health-care debate might think the historic new federal law does little to help older Americans. In fact, emotional talk of “death panels” likely led more than a few people to expect bad news for end-of-life care.

It’s true that the new law promises to pay only a tiny share of states’ biggest and fastest-growing health-care bill — long-term care for the elderly and other adults with disabilities. Still, its attention to the issue may end up paying much bigger dividends in the future.

The law, known as the Patient Protection and Affordable Care Act, includes the first national long-term care insurance plan — called Community Living Assistance Services and Supports — a federally administered program financed through payroll deductions. If a significant number of people sign up for the voluntary program, individual long-term care benefits could defray a portion of states’ costs.

But the real gift the new law presents states is a detailed road map to the most successful ways to cut costs and improve services for the elderly. By offering incentive payments of 2 percent to 6 percent of costs, the federal government is encouraging states to adopt and expand successful programs pioneered by a handful of states that give elders more options for their care at much lower expense.

Health reform’s incentive funding for long-term care would flow through Medicaid — the federal-state health insurance plan for the needy — in the form of a slightly increased federal share for certain programs.

It is well known that nearly all seniors and adults with disabilities want to remain in their homes as long as possible, and it’s vastly cheaper for states to provide the help — meals, bathing and dressing, and other home services — that allows them to do so rather than resort to institutionalization. Yet, the majority of those who need long-term care are isolated in facilities estimated to cost at least three times as much as comparable home-based care.

Here’s the problem: Medicaid — which pays nearly 50 percent of all nursing home bills in the U.S. and 40 percent of all long-term care — is biased in favor of institutional care. When seniors qualify financially and are deemed to need care, Medicaid funding for a nursing home bed is guaranteed. But for those who want to remain at home, funding is only a possibility and a national shortage of home-health providers often means long delays.