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Panelists Call for Revamping of Long-Term Care System

By Whitney Blair Wyckoff, CQ Staff

July 15, 2008 -- Overhauling long-term care policies is a key component of addressing challenges that face the health care system as baby boomers age, said speakers at a recent Brookings Institution event on how to improve the quality and sustainability of long-term care programs.

"Unless we take action soon, our nation will be totally unprepared to meet this challenge," said Sen. Susan Collins, R-Maine, noting that over the next 20 years, the population over 65 is expected to double. The event was held by the Engelberg Center for Health Care Reform at Brookings.

Several of the panelists urged a combination of voluntary and regulatory strategies, and they looked to states as leaders in tackling long-term care issues. Panelist Susan Reinhard of the AARP Public Policy Institute pointed to Washington State, which she said has made "tremendous strides" to improve long-term care.

Although the state augmented its long-term care program, it has been able to decrease costs starting this year, she said. Washington's program considers options beyond traditional nursing homes, which Reinhard and other panelists agreed have been overlooked too often.

Seventy percent of people in Washington who qualify for long-term care are enrolled in home- or community-based care, she said. This figure accounts for 54 percent of Medicaid dollars spent on long-term care for older adults in the state. The state also has started using an electronic information system which can evaluate a patient's eligibility for Medicaid services.

Reinhard also said all new nursing home residents meet with a state-employed nurse when they enter a facility, regardless of whether they are in Medicaid.

"One thing that we really need is that federal regulations support, rather than impede, these systems," Reinhard said, explaining that some of the Medicaid regulations have the potential to discourage similar programs.

Mary Jane Koren, assistant vice president at the Commonwealth Fund, emphasized a need for improvement in quality and efficiency. Nurses' aides have a 70 percent turnover rate in nursing homes, and she said the turnover rate for other staff "is equally appalling."

Congressional Budget Office Director Peter Orszag said attempts to revamp the long-term care system could be hindered if lawmakers cannot find a way to offset the start-up costs.

"It is probably the least effective sector of our economy," Orszag said of the health care system as a whole.

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