Broken and unsustainable: the aging of Baby Boomers means a cost crisis in long term care.

When it comes to caring for its older citizens, America faces a looming challenge. There are more than 77 million aging baby boomers who will need some type of support as they age, yet our current long term care system is not sustainable. Regulatory inconsistencies and restrictions, a workforce crisis and fragmented and inadequate funding have created a system that is unable to meet the growing needs of seniors.

Members of the American Association of Homes and Services for the Aging believe our nation deserves a healthy, affordable, ethical long term care system-one where seniors and younger persons with disabilities can get support and care in the least restrictive setting that is equipped to meet their needs. This can be achieved through a coordinated continuum that includes housing with supportive services, community-sponsored programs, in-home care, adult-day care, assisted living and nursing homes.

Public programs--which account for 62 percent of the financing of nursing home care and home health care--include Medicaid, Medicare, state programs, the Veterans Administration and the Administration on Aging. Private financing includes private insurance philanthropy and out-of-pocket payments by individuals and families in need of care.

Instead of a cohesive national policy to ensure access to long term care, our citizens face a "patchwork" of programs that is inefficient, inequitable and often ineffective. Services vary from state-to-state and community-to-community. Each program has its own standards for eligibility, and each provides different services. People most often receive care in the setting in which it can be reimbursed, rather than according to their own needs and preferences.

While consumers face inadequate coverage of nursing homes and other long term care costs that can reach $4,500 or more per month, the current system is equally precarious for long term care providers. Because public funds make up such a large share of resources available for long term care, government reimbursement policies largely determine the amount of revenues that providers have available to pay staff and cover other costs of care. The failure of federal and state payments to keep pace with these costs has made it increasingly difficult for providers to recruit and retain well-qualified staff. This trend is likely to worsen in the future, as the demand for long term care increases.

The following reforms must be made in the present long term care financing system in order to ensure that these services continue to be available as the Baby Boom generation ages:

* Federal payment standards for Medicaid: Provide federal payment standards for state reimbursement of nursing homes participating in the Medicaid program. Broad federal standards must adequately ensure that the rates paid by the states (and matched by the federal government) will cover the cost of hiring, retaining and paying quality health care employees and other costs needed to meet the needs of Medicaid residents.

* Enhance federal matching payments for Medicaid: Either as an across-through to provides, an enhanced federal match would provide funds to pay providers for services rendered. States would be required to adhere to maintenance of effort for state funds.

* Increase funding at least 10 percent for Older American Act (OAA) programs: These programs pay for critical programs and services that enable persons who are frail and/or disabled to remain at home. Title III, State and Community Programs, receives the bulk of OAA funds and provides a broad range of supportive and social services including congregate and home-delivered meals, senior centers, in-home and community-based care, and the new National Family Caregiver Program.

* Increase Social Services Block Grants (SSBG) funding to $2.8 billion, the level authorized in the 1996 welfare reform law. States must also continue to have the right to transfer up to 10 percent of the funds they receive under Temporary Assistance to Needy Families to their SSBG program.

* Review programs such as PACE and SHMOs (Social Health Maintenance Organizations) and demonstrations funded through the Real Systems Change Grant Program to identify and replicate more innovative and efficient home and community-based service delivery systems.

* Support initiatives that create more choice and opportunity for consumers such as authorized to receive home health services in adult-day settings, while ensuring that regulations are not overly burdensome for providers.

* Long term care insurance: As the Baby Boomers reach retirement age within the next decade, state budgets will be less able to absorb the cost of long term care through their Medicaid programs. Federal and state governments must promote private insurance coverage and help to make it more affordable through tax deductions, tax credits, or possibly even direct subsidies for the purchase of private insurance.

* Public education: The public must be better educated and informed about the likely need for long term care, its potential costs to families, and the importance of responsible financial planning to cover these costs.

Bruce Rosenthal is director of media relations for the American Association of Homes and Services for the Aging in Washington, D.C. He may be contacted at 202-508-9499 or via e-mail at [e-mail].

That's what I want

Older, wealthier, more numerous--and more demanding. That's the kind of customer long term care facilities can expect as Baby Boomers reach retirement age in the next decade or so and continue to ask for "the finer things in life."

That said, here's what several long term care facility operators said they expect the next generation of seniors will demand from long term care:

* Apartment life instead of institutional care. Sandra Grant, senior vice president of Health Services at Lakeview Village in Lenexa, Kan., says she's already seeing signs of this preference in the "Silent" Generation most facilities currently serve. "We expect that in about 10 years, technology will allow most people to live independently," she says. "We have already experienced families who have installed cameras in their parents' apartments and have used the images transmitted over the Internet to call and remind them of activities of daily living, such as dressing or taking medications. Technology in apartments promises to help us know when someone falls or might otherwise need to be checked."

* A more home-like environment wherever they live. "The next generations don't seem to be happy about sharing a room with a stranger," Grant says. "They want private rooms that they can personalize" This means offering the Baby Boomers choices in how to live, from being able to help themselves to snacks from refrigerators to watching movies on the entertainment center in their rooms. "We can expect that the next generations will want their life in the facility to be patterned as much as possible like it was when they were at home," Grant says.

* Conveniences, conveniences, conveniences. Baby Boomers will not be attracted to today's somewhat drab and sometimes non-user-friendly facilities. "I anticipate that boomers will look for a variety of services to make their lives easier," says Gary T. Puma, president and chief executive officer of Presbyterian Homes and Services Inc. in Princeton, N.J. "They will want things like dry cleaning pick up, convenience stores with pre-prepared foods, restaurant reservation services and pharmacy delivery services. For us, that will mean adding even more convenience in the form of expanded concierge and hospitality services."

* Where's the Web? If you don't offer computers and/or Internet access, don't be surprised if many Boomers pass you by, according to Puma. "[Based on] the way that this generation has embraced computers and new technology, Internet access in both public and private areas will be a must," he says.

Susan Wood, executive director of Monroe Village, a CCRC in Monroe Township, N.J., agrees with Puma, adding that seniors will expect their rooms to have adequate space for a computer workstation. They'll also want additional elements of today's technology" where they live, such as DVD players and flat screen or plasma television sets.

* Wellness and exercise programs are a must. Baby Boomers are a very active, health-conscious lot--the U.S. Forest Services notes that Boomers' top 10 leisure activities include walking, swimming, bicycling, hiking, golf and motorboating--and this will carry over to their stay in long term care facilities, according to Grant.

"Consumers are already looking for indoor pools, water aerobics or water exercises targeted toward individuals with arthritis or other conditions," she says. "We believe that the coming generations will be more interested in staying healthy so they can continue to enjoy the activities important to them."--A.N