On September 18, 2013, the Commission on Long-Term Care released a report that includes 28 proposals for legislative and administrative action to promote the establishment and financing of a long-term care services system that will ensure the availability of such supports for those who need them.
According to the Commission, 70% of Americans ages 65 and older rely on some form of long-term services and support (LTSS). About 12 million Americans receive support from LTSS today, but existing problems with the organization and financing of the services will only be exacerbated as the Baby Boomer generation ages.
Their report is the result of the efforts of 15 politically-appointed commissioners over the period of 100 days. They held four public testimony hearings and welcomed recommendations from the general public, which ALFA contributed to. The report was compiled over the course of nine executive sessions and was passed by a 9-6 vote to be presented as the final agreement from the Commission.
Identifying the Issues facing Long-Term Care
The Commission identified the following problems with the current LTSS system:
- Currently, family caregivers are providing most of the care, but their responsibilities can be very overwhelming. Their availability will decline as more of the population ages.
- Many Americans approaching retirement are unaware of how costly paid LTSS are and are not prepared for these expenses.
- There are training and retention problems within the direct care workforce that will affect the quality and accessibility of practiced employees in the future.
- Paid LTSS are fragmented and difficult to access. They often lack the focus and efficiency that would result in the best outcomes, all the while remaining a financial burden.
Additionally, the Commission endorsed a three-pronged vision statement, which addresses the need for regulatory advancement in terms of LTSS service delivery, workforce, and financing. The vision statement encourages a more integrated and financially sustainable LTSS delivery system that is built around the concept of person- and family-centered care. They hope to ensure that quality services are accessible, available in whichever setting consumers choose, and at a lower overall cost.
In terms of workforce, the vision statement references an LTSS that is able to both attract and maintain a sufficient number of knowledgeable employees. Lastly, the vision statement calls for a variety of financing options that will enable those who use or are likely to use LTSS greater certainty by protecting them against extreme costs of services, promoting financial planning and preparation, and providing a safety net for the lower-income population.
Proposed Solutions
In the report’s recommendations section, the Commission endorses, among other measures: incentivizing the state provision of LTSS; implementing a standard quality assessment tool; making LTSS services more available to consumers with a focus on home and community-based care; and elevating standards for the LTSS workforce, including enabling criminal background checks. However, a major criticism of the report is that the Commission failed to reach an agreement regarding the financing of long-term care services, which is arguably the most important healthcare issue of today’s political climate. The commissioners instead proposed two different approaches: private options and a government insurance program.
The commissioners emphasized that they believe the report to be a foundation for more extensive work that needs to be done to improve the organization and financing of LTSS. To move forward, they recommend the creation of a national advisory committee and a convening of 2015 White House Conference on Aging in coordination with the National Disability Council to focus on LTSS.
A video of the public session to release the Commission’s final report (September 18), as well as the slide presentation used for reference during the meeting, are available Commission on Long-Term Care website.
Read the pre-publication version of the Commission on Long-Term Care’s Report to Congress or view the alternative report: A Comprehensive Approach to Long-Term Services and Supports.
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