Long Term Care is Essential for Systems of Care

14 December 2009

 

I was cleaning out some files and my bookcase and found files and Healthcare Advisory Board materials related to the Clinton Health Care Plan.  Lesson learned – either clean out the bookcase more often or everything old is new again.

 

The pending healthcare reform legislation is apt to create a significant change in the cost, delivery, and process of healthcare in the United States.  For months the debate has been extended with lines drawn and elected leaders suggesting they are creating legislation that reflects the desire of their constituents and was in the best interest of the nation.  The potential for congruence between these objectives is slight to say the very least. 

 

An Internet search on response to healthcare reform directs the reader to a source that writes:  “the initiatives taken by the President, and his advisors, for the Nazi health-care reform, and the counteroffensive led by LaRouche PAC, which has put the President’s plan in danger of its well deserved death.”[i]    Fearing the inability to pass initial Social Security legislation, President Franklin Roosevelt decided not to include healthcare because President Roosevelt had decided that “health insurance should not be injected into the debate at that point, nor should the final report on health be made public as long as the social security bill was still in the legislative mill.”

 

The debate ensues and President Barack Obama is hopeful to have legislation on for his signature before 1 January 2010.  One curious aspect to the give and take of the political side of the debate is how Long-Term Care is being dealt with.  A House proposal (under debate in the Senate as of 14 December 2009) is a new federal insurance program — Community Living Assistance Services and Supports Act (or Class Act).  Reporting on this element of Reform notes funding for this program will be derived from voluntary payroll deductions (premiums) and cash benefits will be paid to Americans with cognitive impairments or individuals unable to perform two or three of a set of defined daily-living activities.

 

This program would enable elders and those with severe disabilities to remain in the community longer; benefits could also be used for long-term care or assisted living facilities.  Critics charge this program fiscally could not be sustained and would precipitate serious fiscal problems down the road.  Subsequently, the programs inclusion is in jeopardy.

 

At the core of reforming the system of care is the system itself.   The medical home model, often touted as a solution, emphasizes the ability of the individual to remain connected to those services, systems, and people that enhance their well-being.  Any opportunity to expand long term care benefits and opportunities should be embraced – they mirror the cultural foundation of the nation, our community, and healthcare systems.    Currently Medicaid (current federal-state health care program for the poor) provides approximately 40 percent of the cost of long-term care in the United States.  Long term care totaled $178 billion in 2006.

 

In the New England Journal of Medicine, a recent Perspective piece[ii] two models of patient care are discussed – including the medical home model.  The ability to sustain sites of care imperative to enhanced healthcare for the nation within a Reform context is essential.

 

The “patient-centered medical home” (PCMH) and the “accountable care organization” (ACO) are two widely discussed models for delivery-system reform that take complementary approaches to achieving these goals. The PCMH model emphasizes the creation of a strong primary care foundation for the health care system, and the ACO model emphasizes the alignment of incentives and accountability for providers across the continuum of care.

 

Long term care is not the salvo for the system; it is a foundation for a generational change in how, where, and when patients receive care.   Perhaps as the debate draws to a close, our legislators and their staff should review their book shelf and files to see if it is up to date and inclusive.