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Monday, July 13, 2015

Progress on Long Term Services and Supports, White House Conference on Aging Starts

Lee Goldberg, National Academy of Social Insurance

Many in the aging community have been underwhelmed by the 2015 White House Conference on Aging (WHCOA), a year-long process that culminates this week with a national summit and an address from President Obama. The 2015 WHCOA may lack the sharp definition of past events. No one will confuse this year’s summit with the first White House conference in 1961 with its focus on the need for health insurance for seniors. But, the 2015 WHCOA may be just the one we need, given the reluctance of so many to address the deep societal issues triggered by an aging population.

After all, most people are concerned less about abstract policy issues and more about everyday aging issues: access to reliable and well-trained caregivers, flexibility in their workplace, a well-designed transportation system and a pleasant community. Most consumers are less concerned with abstract issues of federalism and more about making sure they have access to the same supports and services, no matter where they choose to retire. A decennial event, this WHCOA will have succeeded if it enages the public around caregiving and moves the country further along in realizing the potential benefits of an aging society and the need for policy action to fully realize those benefits.

Many had hoped that this year’s conference would focus on the need for a comprehensive policy addressing the financing and delivery of long term supports and services (LTSS). But that was never likely. LTSS has been a polarizing issue for decades, raising concerns about the role of government in society and our fiscal health as a country. This is an Administration that is experienced enough to know that even if there was a broad consensus around the financing of LTSS, making it a domestic priority would only further polarize the issue.

A quiet resurgence for long-term services and supports
LTSS may be about to have a quiet resurgence independently of the WHCOA. Among many long-time advocates and experts, there seems to be agreement at least on how to frame the discussion of the financing and delivery of LTSS.  That may not seem like much, but it is difficult to come to a consensus if two sides define the problem differently. I have been part of a group of individuals and organizations known as the Long Term Care Financing Collaborative that has been meeting regularly over the last three years to seek common ground on LTSS financing issues. Led by Academy members Howard Gleckman of the Urban Institute, Jonathan Westin of the Jewish Federations of North America and Stuart Butler of the Brookings Institutution, this group has been meeting to consider pragmatic hybrid solutions that require action by both the private and public sector. Although we have yet to agree on specific policy recommendations, this diverse group consisting of conservatives and liberals has agreed on a fundamental principle: we need to move from welfare-based model of care, in which a means-tested program like Medicaid is the primary payer of LTSS, to an insurance-based model in which the financial risk of needing LTSS is spread broadly among the population. The other principles and the broad vision statement agreed to by the group can be found here.

Other coalitions and organizations have developed LTSS principles in the past, hoping to jump-start the debate. The Leadership Council of Aging Organizations and the Consortium of Citizens with Disabilities worked together to craft a set of joint principles that sought to unify the aging and disability communities – two groups that come to the LTSS debate with different priorities.  But the Long Term Financing Collaborative may be the first group in a while to create principles that span the ideological spectrum.

Can we build on the recent efforts of the Collaborative and others groups to attract broader support for a new model of long-term supports and services? Can we enlarge the table at which these discussions are being held? Can we turn these important but rather lofty principles into more concrete policy recommendations that address a portion of the financing problem most families face? Stay tuned.

Posted on July 13, 2015  |  Add your comment
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For those who are interested in seeing the latest data, ASPE just released a report on the risk for seniors of needing LTSS services, using the Urban Institute's latest dynamic microsimulation model. Fascinating numbers that continue to show a fairly high risk of seniors needing some LTSS but a wide-range of needs and expenditures. The report is available at http://aspe.hhs.gov/daltcp/reports/2015/ElderLTCrb.pdf.

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