LTC Bullet: Moses vs. Grabowski on Long-Term Care

Friday, February 25, 2022

Seattle—

LTC Comment: Is government the problem or the solution for long-term care. Two conflicting views after the ***news.*** [omitted]
 

LTC BULLET: MOSES VS. GRABOWSKI ON LONG-TERM CARE

LTC Comment: David C. Grabowski, PhD, is Professor of Health Care Policy in the Department of Health Care Policy at Harvard Medical School. Professor Grabowski is omnipresent in the news about long-term care. Stephen A. Moses is president of the Center for Long-Term Care Reform. His media megaphone is more subdued. But both were featured yesterday in McKnight’s Long-Term Care News. Their differing views on what ails long-term care services and financing provide food for thought about this complicated topic.

Grabowski is featured in a McKnight’s article by editor Kimberly Marselas titled “These 10 steps needed to save skilled nursing, experts say.” In a special issue of the Annals of the American Academy of Political and Social Science, Grabowski and co-author Brian E. McGarry, Ph.D. propose

Paying higher wages for direct care workers, adopting meaningful regulatory reform, increasing the presence of advanced practice clinicians in skilled nursing facilities, and realigning Medicare and Medicaid rates … Increasing wages for direct care staff and ensuring minimum staffing requirements … an infusion of federal dollars that nursing home operators would have to spend on wages or other staff benefits … more physicians, physician assistants and nurse practitioners to work routinely in long-term care settings …revisit an approach like the Boren Amendment — which required states’ Medicaid nursing home rates be “reasonable and adequate” — but to give it more teeth … increasing financial and ownership transparency; bolstering alternate models of nursing care, including the small house model; increasing use of home- and community-based services while ensuring the future viability of skilled nursing care; and offering better long-term care financing as a nation.

What do all these ideas have in common? They rely more than ever on the failed government central planning and regulation that already dominate long-term care services and financing. They do more of what has already been tried unsuccessfully but at much higher cost. To his credit, Grabowski acknowledge “In terms of finding the dollars, the political will, I don’t think that we’re there yet as a country ….”

Moses has a different view of long-term care’s problems and their solution. In a Guest Column for the same issue of McKnight’s titled “Trappings of LTC system leave operators trapped,” simply “Trapped” was his title for the piece, Moses writes:

Long-term care operators are trapped in a public financing system that pays too little, expects too much, rewards cronyism, discourages creativity, punishes profit making and disserves aging Americans … New ideas and creative caregiving approaches hit a brick wall of inadequate funding, bureaucratic red tape, political indifference and ideological bias. No one thrives in the publicly financed long-term care system we have now, least of all the aging Americans so poorly served by it. … In a free market, prices are set by supply and demand, not by government decree or pressure. So prices would reflect the kind, amount and quality of care options for which people are willing and able to pay … Profit-seeking entrepreneurs would revolutionize the LTC system with heretofore unimagined options if we would just get the government out of their way and let it happen … Home equity, if not protected by Medicaid’s huge exemption (up to $955,000), represents $9.2 trillion of wealth held by older people, that should, could, and would flow quickly into the long-term care financing market. 

Moses argues that government funding and regulation of long-term care since Medicaid and Medicare arrived in 1965 are exactly what caused the system’s problems of institutional bias, poor access and quality, inadequate funding, caregiver shortages and a public oblivious to long-term care risk and cost. So, doing more of the same, as Grabowski and McGarry propose, would only make these problems worse.

Today’s LTC Bullet gives you only a hint of what these authors are saying. We encourage you to read more by both. You’re likely to find Professor Grabowski in virtually everything you read in the LTC media. For Moses’s views, see Medicaid and Long-Term Care and join the Center for Long-Term Care Reform to find 1,328 of his LTC Bullets archived chronologically and by topic. Check out Stephen A. Moses on Google Scholar or find his many national and state-level studies here. The Center for Long-Term Care Reform’s “Membership Levels and Benefits” schedule is here.