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The Commonwealth Fund Health Care Opinion Leaders Survey: Assessing Health Care Experts' Views on Long-Term Care

Country: United States

Survey Organization: Harris Interactive, Inc.

Field Dates: November 9, 2005–December 5, 2005

Sample: Peer-nominated experts in health care policy, finance, and delivery

Sample Size: 246 (survey successfully e-mailed to 1,287 potential respondents; the response rate was 21 percent)

Interview Method: Online/E-mail

The latest Commonwealth Fund Health Care Opinion Leaders Survey was conducted by Harris Interactive on behalf of The Commonwealth Fund, with a broad group of nearly 250 opinion leaders in health policy and innovators in health care delivery and finance. This was the sixth in a series of bimonthly surveys designed to highlight leaders' perspectives on the most timely health policy issues facing the nation. This survey focused on the nation's long-term care needs.

With the aging of the baby boom generation and the increasing life expectancy of Americans, health policy experts are rightfully concerned about the array of long-term care services that will be required to provide the elderly with proper care. While some countries have already adopted measures such as mandatory long-term care insurance, the U.S. is still debating how to finance long-term care as well as improve the quality of services provided. We asked opinion leaders from our panel to weigh in on approaches to paying for the country's long-term care needs and policy strategies to manage the growing cost of long-term care. Concerns about the quality of long-term care have also been raised, so opinion leaders were asked to share their thoughts on the effectiveness of a number of approaches that would assure high-quality care. Panelists were also asked about their familiarity with a movement best known as "culture change" or "resident-centered-care," which seeks to humanize nursing homes and other long term-care facilities and improve quality of life for residents and staff.

Potential respondents for this series of surveys were identified through a two-step process involving 1) a "nomination" survey with a core group of experts in multiple fields to nominate additional leaders both within and outside their areas of expertise and 2) a review of published lists and directories of recognized health experts.


Who Should Pay for the Long-Term Care Needs of Americans?

There is no silver bullet for dealing with the cost of long-term care, according to panelists. Yet opinion leaders agree that individuals in need of long-term care should not be left to fend for themselves. Instead, government and individuals should share responsibility, the findings show. Although none of the payment approaches presented to opinion leaders captured an enthusiastic majority, more than half of respondents (61%) believe that individuals and government should share the responsibility for financing long-term care about equally. This is the most-endorsed approach among leaders from all sectors: academic/research institutions, health care delivery, business/insurance/other health industry, and government/labor/consumer advocacy. Nearly half of panelists (47%) believe that adult children should take on some of the burden and be expected to contribute in part to their parents' long-term care needs. There is also a substantial minority of leaders (41%) who believe that government should cover all or most long-term expenses. Only one in three panelists (33%) agree that employers should be expected to contribute in part to their employees/retirees long-term care costs. The least popular approach in this category is making the individual mostly responsible for long-term care costs, with only 26 percent of opinion leaders agreeing that this is the solution. Not surprisingly, panelists from the business/insurance/other health industry sector are much more in favor of this approach than their colleagues from academia or the health care delivery sectors.

The Growing Cost of Long-Term Care

Leaders favored two strategies when presented with a range of options to address the growing cost of long-term care services—adding a long-term care insurance benefit to Medicare, financed by a premium (80%), and providing tax incentives for individuals to purchase private long-term care insurance (75%). Fewer respondents, but still a majority, favored transferring responsibility for Medicaid long-term care from states to the federal government (68%), letting individuals establish tax-favored medical savings accounts to purchase long-term care insurance (63%), and tighten rules and state enforcement of Medicaid asset transfer restrictions (61%).

Less popular was a strategy of giving frail elderly and disabled Medicaid beneficiaries vouchers to purchase their own long-term care services. As the only proposed policy option in this category that did not gain the support of a majority of respondents (40%), this approach is the least favorite among respondents of all sectors. Support of the other strategies varied by sector.

Assuring and Improving the Quality of Long-Term Care

Most panelists supported a range of strategies designed to assure and improve quality of care in home health care, nursing homes, and assisted living arrangements, but show no overwhelming enthusiasm for any of them. About two-thirds of leaders rate as effective in improving high-quality care strategies such as increased availability of consumer report cards on nursing home and home health care (66%); payment incentives for quality such as pay-for-performance (66%); and more effective use of state enforcement remedies and sanctions against low quality providers (65%). Most also support increased payment rates to providers of long-term care services (59%) and the establishment of staffing requirements for nursing homes (57%). Again, no clear favorite strategy emerged. However, less than half of the leaders (45%) say that they think that the provision of technical assistance to improve quality through the Medicare Quality Improvement Organization program is an effective way to ensure and improve quality of care.

Overall, there is substantial consensus among the panelists regardless of sector. However, respondents from the business/insurance/other health industry are more likely than leaders from academia and health care delivery to endorse the increased availability of consumer report cards. They were also more likely than those in academia and government/labor/consumer advocacy to consider payment incentives an effective way to improve quality of care.

"Culture Change" or "Resident-Centered" Care

Over the last few years a movement called "culture change" or "resident-centered care" has emerged within the nursing home community, part of an effort to improve the quality of care provided nursing home residents. However, only about one in four opinion leaders responding to the survey (27%) is familiar with this effort. Thirty-five percent report that they are somewhat familiar with the movement, but 37 percent say that they are not at all familiar with it or have never heard of it. Interestingly, the level of familiarity does not vary by sector.

Among leaders who are at least "somewhat familiar" with "culture change" or "resident-centered-care," only about one in four (26%) feel that it's been effective in its goal, but nearly half say that they would rate it "somewhat effective." Of those who were at least somewhat familiar with this movement, 28 percent were not sure whether it has had any impact.


The online survey was conducted by Harris Interactive with 246 opinion leaders in health policy and innovators in health care delivery and finance between November 9th, 2005, and December 5th, 2005.

The sample for this survey was developed by using a two-step process. Initially, The Commonwealth Fund and Harris Interactive jointly identified a number of experts across different industries and professional sectors with a range of perspectives, based on their affiliations and involvement in various organizations and institutions. Harris Interactive then conducted an online survey with these experts asking them to nominate others within and outside their own fields whom they consider to be leaders and innovators in health care. Based on the result of the survey and after careful review by Harris Interactive, The Commonwealth Fund, and a selected group of health care experts, the sample for this poll was created. The final list included 1,287 people.

Harris Interactive sent out individual e-mail invitations containing a password-protected link to the entire sample. Of the 1,287 e-mail invitations, 136 were returned as undeliverable. Harris Interactive determined that the undeliverable e-mail addresses appeared to be randomly distributed among the different sectors and affiliations. Data collection took place between November 9th, 2005 and December 5th, 2005. A total of five reminders were sent to anyone who had not responded. The response rate was 21 percent. Typically, samples of this size are associated with a sampling error of +/- 6%.

Health Care Opinion Leaders Survey Part I, Assessing Health Care Experts' Views on Policy Priorities

Health Care Opinion Leaders Survey Part II, Assessing Health Care Experts' Views on Health Insurance

Health Care Opinion Leaders Survey Part III, Assessing Health Care Experts' Views on Health Care Costs

Health Care Opinion Leaders Survey Part IV, Assessing Health Care Experts' Views on Medicare and Its Future

Health Care Opinion Leaders Survey Part V, Assessing Health Care Experts' Views on Medicaid and Its Future