Saturday, November 7, 2009

Long Term Care and Health Care Reform.

New America has a story on the necessary but neglected attention paid by health care reform efforts to long term care for elders:

The disjointed system of care for elders fails to cover — not even through Medicare — long-term assistance for persistent conditions and frailty. Medicare only covers acute-care conditions, such as broken hips or strokes. But once a stroke victim becomes medically stabilized, for instance, Medicare does not pay for extensive rehabilitation or therapy needed for a person to fully recover the ability to move or communicate.

Unlike any other economically advanced country, continuing-care coverage available to older Americans and people with disabilities is available mainly through Medicaid, a poverty program forcing people to "spend down" until they are poor enough to qualify. Private long-term care insurance is generally unreliable and covers only 6 percent of older Americans.

This reporter followed up with Shalala, “What about even Sen. Kennedy’s CLASS Act?” (It stands for the Community Living Assistance Services and Supports Act.) Shalala repeated, sharply this time, "We're not there, yet." So don't bet on that provision getting to the president's desk — if any health care bill does.

Shalala did observe, though, that change might come eventually: "If we can get to chronic care management and some way of reimbursing people, we may be able to cobble together a serious long-term care plan.” She said some hospitals are starting to organize LTC programs by adding services, such as chronic care management, and working with hospices for those with terminal illness.

“But,” she stressed, “We're cobbling together, and it's not a seamless system."

Although Shalala's political instincts are instructive, the notion of covering one kind of care without the other makes little sense to many prominent experts. At the recent On Lok Annual Conference on eldercare, held in San Francisco, Joshua Wiener stated, "This kind of fragmentation in particular doesn't work well for people with chronic illnesses, chronic conditions, people with disabilities."

ht: Margaret Morganroth Gullette

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