New York, NY, July 21, 2008—Adequate financing for long-term care, improving the quality of long term care services, and developing an adequate, skilled workforce are some of the urgent challenges facing long-term care in the future, say four of five respondents to the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey. Nearly four of five (79%) respondents favor or strongly favor adding a long-term care benefit to Medicare, financed by a premium, to pay for care.
More than two-thirds (69%) of respondents to the survey believe it is very important (41%) or important (28%) that the health reform plans of the presidential candidates address the quality and financing of long-term care. Opinion leaders surveyed include experts from four broad health care sectors: academia and research organizations; health care delivery; business, insurance, and other health industry; and government and advocacy groups. Elected officials and media representatives were excluded.
"As our population ages, health care opinion leaders are sounding the alarm about the significant challenges we will face financing and improving the quality of long-term care," said Commonwealth Fund President Karen Davis. "Although health care leaders say long-term care is important to include in health care reform plans, the presidential candidates have not yet addressed this issue, which is certain to become an increasing concern for American families."
A majority of health care opinion leaders say that long-term care costs should be shared by individuals and the government (55%), while one-quarter (26%) say costs should be shared by individuals, employers, and the government.
Other findings from the survey include:
- Three-quarters (76%) of opinion leaders say it is urgent or very urgent to develop a sufficient supply of home- and community-based services; 67 percent say it is urgent to create and disseminate adequate information on long-term care facilities to better educate consumers and families about available options.
- To finance long-term care, opinion leaders most favored a proposal that would add a long-term care benefit to Medicare financed by a premium (79%); fewer respondents, though still a majority, favored providing tax incentives for individuals to purchase private long-term care insurance (64%), and transferring the responsibility for Medicaid long-term care from states to the federal government (63%).
- Three-quarters (74%) of respondents say using payment incentives to promote quality would be effective in assuring and improving quality of care in home health, nursing homes, and assisted living arrangements.
- Three of five (61%) health care opinion leaders say increased public availability of quality and price information on nursing homes and home health care would be an effective way to improve quality, and 56% said having a full-time physician or nurse practitioner on site would improve quality of care.
- When considering effective strategies for helping consumers make informed choices about long-term care, majorities of opinion leaders cite several strategies as effective or very effective, including: care coordination services (74%); counseling services to help people navigate service options (74%); having a medical home to link families and services (68%); ensuring that hospital discharge planners are informed about services in their community (67%). Fewer than one-third (29%) say general public information campaigns to stimulate planning for the future would be effective.
- A majority of opinion leaders (66%) are at least somewhat familiar with the culture change movement in long-term care, which is working to make resident, or person-centered care the norm and the nursing home less institutional and more home-like in order to preserve residents' rights to make decisions affecting their daily lives. Familiarity with culture change appears to have increased since a 2005 health care opinion leaders survey: In 2005, 27% of respondents said they were either extremely familiar, very familiar, or familiar with culture change in long-term care; in 2008 38% of respondents said they were very familiar or familiar with the culture change movement.
The survey is the 15th in a series from The Commonwealth Fund, and the seventh conducted in partnership with the publication Modern Healthcare. Commentaries on the survey results by Nora Dowd Eisenhower, secretary of the Pennsylvania Department of Aging, and Carol Raphael, president and chief executive officer of Visiting Nurse Service of New York, appear in the July 21 issue of Modern Healthcare. The commentaries are also posted on the Fund's Web site, along with a Commission data brief discussing the survey findings.
Methodology: The Commonwealth Fund/Modern HealthCare Health Care Opinion Leaders Survey was conducted online within the United States by Harris Interactive on behalf of The Commonwealth Fund between June 2 and June 30, 2008, among 1,078 opinion leaders in health policy and innovators in health care delivery and finance. The final sample included 196 respondents from various industries, for a response rate of 18 percent. Data from this survey were not weighted. The complete methodology is available on The Commonwealth Fund Web site.