Friday, March 29, 2002
Seattle--
***
Center News: On Sunday, March 31,
2002, the Center for Long-Term Care Financing completes our fourth full year of
advocating for rational LTC public policy.
And changes are afoot. Executive
Director David Rosenfeld, JD, MSW is leaving full-time employment with the
Center to explore a run for public office and other opportunities to influence
public policy. David will remain
involved as a member of our Board of Directors and as a formal adviser to the
Center. Today's Bullet is an
editorial authored by Mr. Rosenfeld. Although
the piece addresses LTC policy in Washington State, it could just as well have
been written about any and every state in the country. After you read it, stay tuned for our comments on David's
tenure as Executive Director. Amy
Marohn, MS, currently the Center's Director of Marketing and Development,
ascends to the role of Executive Director.
If you've interacted with Amy, you know how capable and committed she is
to the LTC mission. If you haven't
met her yet, make it a point to "shake hands" electronically at amy@centerltc.org
or 425-377-9500 until you can meet her in person at conference sometime. ***
***
As promised in our last Bullet, guidelines for corporate and individual
donor-only zone access have been published on our website at http://www.centerltc.com/DOZ_info.htm.
Titles to be added to the "LTC Week in Review" feature in The
Zone on Monday include:
"Double
Jeopardy on Nursing Home Costs"
"Nursing
Home Association Fights Back Against Medicaid"
"Enron-ing
LTC"
"Tracking
Social Security"
"Nursing
Home Liability Crisis Heightens"
Hint:
We commit to post these "LTC E-Alerts" no later than the Monday
after we announce them. But the
truth is that we often post them the same day we announce them.
So zone in anytime for the latest news and comment on LTC service
delivery and financing. ***
"Long-Term
Care Advocacy Shortsighted"
by
David M. Rosenfeld
"Our
elected officials must provide leadership and the public must offer support for
proper funding of long-term care in this state -- now and into the future."
Thus concluded a recent Seattle Times editorial ("Don't Shortchange
Long-Term Care," March 6, 2002) by James Roe, President of the Washington
Health Care Association (representing hundreds of Washington nursing homes and
residential care facilities). Leadership
and public support, according to the editorial, equals more public funding of
long-term care across the spectrum of care settings (nursing homes, assisted
living, boarding homes, adult family homes, etc.).
Roe advocates not just restoring Governor Locke's proposed cuts in
Medicaid reimbursements, but a general increase in public funding to secure the
future of our long-term care service delivery system. "After all," according to Roe, "every one of
us will someday need to rely on long-term care services . . . .
We must be willing to make the investment and provide the resources to
make certain this care is available when our time comes."
Is
more public funding really the solution?
Roe
is correct that our elected officials should act now. Pumping more taxpayer dollars into our current system absent
critical changes in public policy, however, will do nothing but exacerbate the
crisis now facing long-term care providers.
Washington
State spends an enormous amount of money on providing long-term care services
through the Medicaid program: more
than $615 million in FY 2000. Total
state Medicaid spending for YR 2000 approached $6 billion.* The problem is too many people rely on taxpayers to pay their
long-term care bill. Thus, we must
encourage more private financing of long-term care (through insurance, savings
and investment) so that Medicaid can focus on its intended mandate:
providing care to the genuinely needy.
More public funding will do nothing to achieve this end.
More likely, an increased public commitment will encourage even more
people to ignore the risk of long-term care until it's too late to avoid welfare
dependency.
Less
than 10% of seniors and virtually none of the Baby Boom generation have
purchased long-term care insurance or made other arrangements to pay privately
for their long-term care. Why?
Current public policy rewards people for ignoring the risk. Why
pay premiums, save or invest if you can wait to see it you ever need care and
get taxpayers to pay the bill? No,
most of your neighbors are not planning years in advance to qualify for
Medicaid. Easy access to public
benefits, however, has anesthetized the public to the risk of long-term care and
thus very few people plan ahead. Generous
eligibility rules allow most middle class seniors to walk right onto Medicaid.
More affluent seniors can artificially impoverish themselves (i.e., transfer or
shelter their assets) with the assistance of a professional Medicaid planning
attorney. You've probably seen a
mailer, advertisement or billboard hawking Medicaid planning as a way to avoid
nursing home bills.
Wouldn't
this situation lead to excessive reliance on Medicaid?
Absolutely. Seventy percent
of Washington's nursing home residents are on Medicaid.
It's no surprise, therefore, Medicaid is struggling to reimburse even the
cost of providing care. This is
true not only for nursing homes, but for providers of all long-term care
services which Medicaid funds. There
is every reason to conclude, moreover, that increased public funding will make
matters worse, not better. If
Medicaid expands coverage (in dollars and services) of long-term care without
any changes in public policy, more people will utilize the program's offerings.
Families now struggling to keep a loved one at home precisely because of
Medicaid's limited coverage (primarily for nursing home care) will gladly take
advantage of expanded access. Healthy
seniors and their adult children will feel even less need to plan ahead to pay
privately. The market for private
financing vehicles such as long-term care insurance will evaporate.
The demand for Medicaid planning services will boom.
And taxpayers will look forward to a skyrocketing long-term care bill as
Medicaid becomes the payer of first resort for most of Washington's seniors.
Bottom
line: Medicaid should fund
high-quality long-term care across the spectrum of care settings. It could do so without any new taxpayer money if public
policy encouraged most people to plan ahead to pay privately and Medicaid could
focus on its intended recipients.
How?
The
Center for Long-Term Care Financing's "LTC Choice" framework for
public policy reform is a worthy place to begin a dialogue on how best to grow
the ranks of private payers. The
core concepts of "LTC Choice" are presented in the Center's white
paper titled, "LTC Choice: A Simple, Cost-Free Solution to the Long-Term
Care Financing Puzzle" which is available to read online at
www.centerltc.org. [Specifically: http://www.centerltc.com/pubs/CLTCFReport.pdf
] With the proper incentives in
place, the number of private payers will increase dramatically along with the
fortunes of the entire long-term care service delivery system.
The
Washington Health Care Association should be commended for focusing our
attention on the immediate need to address long-term care financing.
Now let's get busy with public policy reform that will actually produce a
fiscally viable system capable of delivering high-quality care to everyone.
[Note:
The WA legislature has since ended its bruising session without cutting
Medicaid long-term care reimbursement to the relief, no doubt, of the provider
community. There’s not much time
to celebrate, however. Nationwide Medicare cuts scheduled for October are still
looming large while a state budget shortfall of at least $1 billion is already
predicted for the next biennium.]
*
J. Christopher Haugen, et al., "Maintaining Long-Term Care:
Washington Demographic and Economic Trends Threaten Access and
Quality," The Evans School of Public Affairs, University of Washington,
Seattle, Washington, October 2001, p. 6, http://depts.washington.edu/npc/ltc/LTC.pdf.
David
Rosenfeld, JD, MSW, is Executive Director of the 501(c)(3) nonprofit Center for
Long-Term Care Financing in Seattle, WA. He
can be reached at david@centerltc.org or
425-467-6840.
***
David Rosenfeld is an attorney (JD) and a Master of Social Work (MSW).
He combines a mastery of long-term care policy with compassion for aging
and incapacitated Americans, whom we are all trying to serve.
For the past four years, David has run the Center for Long-Term Care
Financing's business operations, but that's not all.
He's written many of the LTC Bullets.
(And his Bullets often get the best feedback.)
He takes media interviews. He
writes articles for publication. He
publishes letters to the editors of important periodicals correcting misguided
articles on LTC. He wins
influential friends in the media, business, and government sectors to our point
of view. Perhaps most important of
all, however, David has been our eyes and ears on the inside of the Medicaid
estate planning profession. As a
lawyer, he has belonged to the National Academy of Elder Law Attorneys.
NAELA is the trade association of attorneys who artificially impoverish
affluent seniors to qualify them for Medicaid nursing home benefits without
spending down. By monitoring
NAELA's email listserve, by tracking their periodicals and publications, and by
attending their conferences and meetings, David made it easier for the Center
for Long-Term Care Financing to report to you in depth on the techniques of and
the damage caused by Medicaid planners. Through
LTC Bullets, media interviews, and meetings with government officials, David and
the Center have made sure that the powers-that-be know about, and have
encouraged them to take action against, all kinds of Medicaid planning abuses.
David Rosenfeld has been and will continue to be a valuable emissary and
educator presenting the truth about long-term care to a largely unaware public,
numbed by denial. The Center for
Long-Term Care Financing and its followers and supporters will dearly miss
David's full-time work and advocacy. But
we look forward to his on-going contributions to and support of the Center and
our common mission. You can reach
David indefinitely at 425-467-6840, ext. 3 and david@centerltc.org.
Please send him your well-wishes and appreciation.
***