Finding Common Ground Amidst the Health Care Reform Debate
by Bruce Chernof
Tuesday, December 1, 2009 13:18
My adopted grandmother has it right–when asked her age, she is perennially 39. Even though she has faced serious medical problems, she still lives in the home she and her husband bought in the early 1950s, aging with vibrancy, with family, with community, and with as much independence as she can muster–and she loves it. This is what all our parents and grandparents want. This is what we all want for ourselves. Secretly we are all afraid that the goals of a meaningful quality of life and independence will elude us as we age. But when I am ready to be perennially 39, I want to follow the path of my adopted grandmother.
The current national health care reform debate provides an important opportunity to lay the groundwork for a better system of services and support for seniors. From a reform perspective, this simply makes good sense. Recent Medicare data shows that those with five or more chronic conditions generate roughly 75 percent of all Medicare spending. Within health care reform we have the opportunity to fundamentally improve the delivery system for those who use it the most and rebalance services so that seniors can remain at home. Given that the average hospital bed in the US now costs $2,714 per day,1 supporting seniors’ desires to remain independent should result in both better care and better use of dollars.
Health care for seniors has always figured into discussions about reform, but the sensitive issue of quality of life and continuums of care were thrust into the national spotlight recently when legislators sensationalized the issue of “end-of-life” care conversations to spotlight their objections to plans for reform. And that’s been just one example of the seemingly intractable nature of our differences on health care priorities for seniors.
Instead I’d propose we remember this very common thread–we are all someone’s children. Millions of Americans are facing very difficult decisions about how they will support their aging parents, particularly whether or not they will be able to help their parents remain at home in communities of their choice.
A recent survey commissioned by the organization I manage, The SCAN Foundation, found that 79 percent of respondents are concerned about their ability to pay for long-term care services. Caring for one’s aging parents has no political party or liberal/conservative agenda–majorities of Republicans, Democrats and Independents had the same concern. Furthermore, the vast majority of Americans, 92 percent to be exact, believe that it is important to improve health insurance coverage for services that help people remain in their own homes, instead of going to nursing homes.2
The SCAN Foundation recently released a report by Georgetown University that delineates several policy options to address the most pressing needs in long-term care financing reform, helps us achieve the goals of health care reform, and sets the nation on a path to a better long-term care system in the future. It is available here.
Sadly, long-term care concerns seem to have no end in sight. The senior population is expected to double by 2040.3 If you don’t have aging parents yet–you will. If you haven’t thought about how mom or dad may need just a little bit of help in the future–you will. If you’ve never toured a physical rehabilitation facility, nursing home, or other eldercare facilities in order to make the best decision for your loved ones–you may have to one day. For some with unique needs, nursing homes provide a necessary and appropriate choice for supportive living. Yet even in these environments, we all wish to make every effort for real choice in our living arrangements, daily activities, culinary preferences, and level and quality of social engagement regardless of our functional abilities–namely living like we are still 39. And, despite our ideological or political differences, it seems like we all understand this–the survey found that 80 percent of people are more likely to support a health care reform proposal that improves coverage for long-term care services for seniors.2
These polling numbers demonstrate that we must continue to advocate for policies that fundamentally improve care coordination for people with chronic health and mental health conditions, rebalance health care services to help make home and not institutions the default choice for seniors, and finally support new program models that give seniors opportunities to live with dignity and independence, at home and in the community, for as long as possible. These reforms will provide older adults of today and tomorrow with a higher quality of life and ultimately reduce the economic burden on our health care system.
Just as parents want the best for their children, every family wants the best for their parents and grandparents. We have the tools and emerging technologies to make life better for the ones we love as they navigate aging. Now we need the political will, quality legislation, and economic support.
Bruce Chernof, MD, FACP, is the President and Chief Executive Officer of The SCAN Foundation.
1Agency for Healthcare Research and Quality – Medical Expenditure Panel Survey, Statistical Brief #256 (August, 2009).
2These results come from The National Omnibus Survey on Long-Term Care, conducted by Lake Research Partners on behalf of The SCAN Foundation (July, 2009).
3U.S. Census Bureau (July, 2009).
Chris Langston says:
December 1st, 2009 at 2:03 pm
I don’t know what people think about the Community Living Assistance Services and Supports (CLASS) Act built into the current House and Senate health reform bills as a way of supporting Americans to age with “meaningful quality of life and independence,” as Bruce describes.
As I understand it (dimly), the program would provide long-term care insurance with a flexible cash benefit of $75 per day. As someone who has considered long-term care insurance repeatedly for my parents and in-laws and me, and always balked – I find the prospect of a stable program, easily administered through wage deductions, with a flexible benefit pretty attractive. CLASS could be what social security is for retirement – not the only source of support you would want, but a good base to build upon. (see http://www.kaiserhealthnews.org/Columns/2009/November/113009Gleckman.aspx)
In any event, thanks for Bruce for the vision he shares of healthy aging and meaningful quality of life. We are very pleased to have SCAN Foundation in the family of aging funders, even if Bruce is only 39.
Paul Jellinek says:
December 2nd, 2009 at 9:58 am
Long-term care reform is the sleeping giant of American health policy. While only 31% of Americans believe that they will benefit from the health reform legislation currently making its way through Congress, the SCAN Foundation found that fully 78% of the public (including 67% of Republicans) said that they or someone in their family would persoanlly benefit from health reform if it included coverage for home and community-based long-term care. In other words, the public already gets what Dr. Chernof is saying. The only question is how long it will take our leaders in Washington to catch on.
Charles A. Smith, PhD says:
December 2nd, 2009 at 4:24 pm
While in the narrow sense I agree with Dr. Chernof, I am concerned that all of these policy discussions (including virtually everything at the recent GSA conference) has a tendency of falling victim to the observer who is too close to the elephant to see what it really looks like. Yes, most everyone wants to continue living in their homes. Yes, most everyone wants to be independent and have a high quality of life. Yes, everyone wants health care access and all the medical procedures that they can get to support their own personal health. The problem is that we live in a world with hard constraints and limits (not that we recognize them in the USA). We have huge problems that transcend age, political parties, and geopolitical boundaries. Thinking narrowly on issues leads us into dilemma’s such as faced by the State of California where referendums express the desire of citizens for more and more services, and less and less taxes. At some point it just doesn’t work. Likewise with older adults and remaining independent and vital … we need to at least nod our heads in the direction of constraints and figure out what maximizes utilities and benefits for society at large, if not always for specific individuals. Maybe a widow(er) living independently in a 2,500 square foot single family home in the suburbs … while their desire … isn’t necessarily the best thing for society at large. Given the constraints of funding, global warming, transportation, etc etc … we (as advocates for older adults) have to be willing to think broadly about how the needs of individual seniors mesh with both the needs of seniors as an aggregate, as well as people of all ages (in the USA and beyond). We need to think outside the box of our own parochial interests. If quality of life and dignity are our ultimate priorities and goals … then we also need to figure out where and what we’re willing to sacriface in order to afford them.
Ron Kustek says:
December 3rd, 2009 at 2:53 am
Finding the best living situation for our loved ones is something we all must strive for when choosing geriatric care. There is a lot of help when it comes to caregiving.. Living at home is something that we all want to do for as long as possible, but if we need to move into a retirement home, assisted living home, nursing home, continuing care retirement community, or in hospice care we can hope there is the financial support to help us with the transition.Fortunately, there is a website dedicated to helping people find geriatric care and housing options, http://www.GeriCareFinder.com offers help.
Seth Landefeld says:
December 5th, 2009 at 5:31 pm
I applaud Bruce’s point that the need of each us to care for our parents, today or in the future, provides common ground for all. In Geriatrics, we need to discover how to build on this common ground to increase support for our field and our patients.
Senior Assisted Living says:
January 8th, 2010 at 1:28 am
It may sound corny, but attitudes like those can really be life changing. I believe that we all should give inspiration to elders – and even to ourselves – to adopt such routines. Retiring is another of many transition stages in life, and it can be psychologically demanding. An assisted living home is a way to give elders support through activities, health care and a professional support staff. While researching for assisted living facilities in the Lehigh Valley of Pennsylvania for my parents, I stumbled upon a very professional company, DevonHouse Assisted Living. Their website (www.devonhouseassistedliving.com) is filled with useful information on this topic, providing many testimonials on how retirement can be full of pleasant times.