The 2005 White House Conference on Ageing is scheduled for December in Washington, D.C. This once-a-decade Conference will be the fifth in the series dating from 1961. While past Conferences had all dealt with numerous issues as they should, each Conference had its major focus — for example, health care in 1961, income maintenance in 1971, and social security in 1981. What should be the major focus of the 2005 Conference? I nominate long-term care, despite the fact that social security reform has dominated discussions of domestic policy this year.
Long-term care may be defined to include medical, social, and personal services for the benefit of persons with chronic physical and/or cognitive impairments, delivered at their homes, in the community where they can access, or in congregate settings such as a nursing home or an assisted living facility in which they live. The objective of such services is to help chronically disabled individuals, many of whom are at the final phase of life, to maintain as much independence as possible in meeting daily living needs.
There are many issues involved in long-term care. For example, what are the types and amounts of services needed and who should deliver them and how? And who should pay for the expenses incurred and how? While these inter-related issues are all significant, the purpose of this article is to discuss how to fund long-term care. Although the situation in the United States is under discussion, some of the implications may have possible relevance for other countries as well.
The article is organised as follows. Section 1 briefly describes the new reality of ageing and dying and its implications for the need for long-term care. Section 2 reports the recommendations on financing long-term care from a ‘mini-conference’ of the 2005 White House Conference on Ageing. This is followed by a description of the current funding pattern of long-term care (Section 3) and a summary of a proposed Social Security/Long-Term Care (SS/LTC) plan (Section 4). Section 5 concludes with a brief discussion of the intragenerational funding model that underpins the SS/LTC plan. To illustrate a similar approach, the article includes an appendix, which is a statement by a task force on health care reform during the administration of President Bill Clinton.
2. New Reality of Ageing and Dying
Increasing longevity has changed the reality of ageing and dying during the past century, making long-term care a more pressing policy issue than is commonly appreciated. As observed by Lynn and Adamson (2003), in 1900, relatively few people had lingering disabilities arising from an eventually fatal chronic illness because death came, more likely than not, abruptly in an era when life expectancy averaged only 47 years.
Now, life expectancy averaged about 75 years in 2000. More people survive into older ages due to improved public health and better medical treatments. “But no matter how carefully we protect our health, eventually, each of us will become sick, frail, or disabled from one or more conditions that result in ongoing illness leading to death” (Lynn and Wilkinson, 2005). Consequently, many older Americans now face chronic illness and disability in the final years of life (Lynn and Adamson, 2003), requiring assistance for their daily living.
That long-term care financing has become an increasingly significant policy issue has not gone unnoticed. The following is but the latest example, cited here because of its affiliation with the 2005 White House Conference on Ageing.
3. Mini-Conference on Long-Term Care
In April 2005, a meeting under the title, ‘Establishing a Comprehensive National Long-Term Care Policy,’ was convened in Washington, D.C. by the following organisations: AARP, American Council of Life Insurers, American Health Care Association and National Center for Assisted Living, America’s Health Insurance Plans, National Alliance for Caregiving, and National Association for Home Care & Hospice.
Designated a ‘mini-conference’ event by the 2005 White House Conference on Ageing, the purpose of the meeting was to provide the policy committee of the Conference with recommendations specific to long-term care that could be considered for incorporation into the Conference’s final policy recommendations to the President and Congress.
One of the major purposes of the mini-conference was to formulate long-term care financing recommendations “to enable our nation to achieve sustainable, affordable and efficient long-term care” (Mini-Conference on Long-Term Care, 2005). They reported the following three recommendations on financing.
Recommendation: Coverage for all Americans through Public AND Private Mechanisms
It is recommended that Congress and the Administration take steps to achieve long-term care coverage for all through participation in public and private risk pools. With respect to expanding public risk pools for long-term care, Congress must establish a new public program that provides basic services for chronic care to all Americans.
With respect to expanding private risk pools for long-term care, Congress must enact laws to encourage private participation by individuals and families for long-term care services, such as tax incentives for the purchase of long-term care insurance and/or other private options for financing long-term care.
Recommendation: Use Current Public Dollars More Efficiently, Intelligently
It is recommended that Congress and the Administration improve the use of health and long-term care dollars across programs by leveraging current funding to maximise efficiency, and to employ best practices from demonstration projects and private sector initiatives on long-term care.
Recommendation: Launch a National Long-Term Care Education Campaign
It is recommended that Congress and the Administration develop and launch a national educational campaign on long-term care that focuses on the risks, costs, and need to pre-fund long-term care.
The campaign must be premised upon a credible advocate or group of advocates to elevate national focus on long-term care issues and awareness.
Additionally, a Congressional or Presidential Commission should be formed to address the nation’s long-term care needs and to formulate steps to reform our long-term care financing system.
The mini-conference concluded that overall, there was recognition that government cannot do everything and that a public/private approach is necessary to create and implement policies that will provide access to quality long-term care and supportive services in an economical and equitable manner. It was also noted that not all individuals are taking as much personal responsibility for their health and long-term care needs as they are able.
Yung-Ping Chen holds the Frank J. Manning Eminent Scholar’s Chair in Gerontology, University of Massachusetts Boston, MA 02125, U.S.A. Recently named a delegate to the 2005 White House Conference on Aging, he had attended the 1971, 1981, and 1995 White House Conferences on Aging and the 1998 White House Conference on Social Security. A founding member of the National Academy of Social Insurance, he served on the panel of the 1979 Advisory Council on Social Security. He may be reached at [firstname.lastname@example.org] or [email@example.com].
Tags: ageing and health, Long Term Care