Candidates do talk about long-term care.

Congress is not in session while this column is being written. In fact, Congress has been recessed a lot this year while many of its members devote their time to the urgent business of running for reelection.

Those of us who follow long-term care issues generally want care for the elderly to be a topic in congressional elections. There is consistent hope that discussion will lead to awareness of the serious problems threatening the survival of nursing homes and, eventually, to legislative solutions. At the very least, congressional candidates should mention the fraying patchwork that passes for healthcare financing for the elderly and suggest how they might change it.

Lo and behold, there are a handful of races in 2004 in which a candidate has actually talked about our issues--albeit to mixed effect. One of these is the hard-fought Democratic primary in Missouri's 3rd Congressional District, where Joan Barry is one of several contenders vying to succeed retiring party leader Dick Gephardt as the congressional representative of the St. Louis suburbs. Barry is a state legislator, as well as an RN at St. Anthony's Medical Center in St. Louis, working in obstetrics and gynecology. She is also a member of the State Technical Advisory Committee on the Quality of Patient Care and Nursing Practices and, until recently, vice-chair of the Health Committee of the National Conference of State Legislatures.

One pivotal issue for Barry is her service on the Missouri House Interim Committee on Nursing Home Caregiving. The committee was charged with investigating nursing home operations, particularly in rural areas, and has studied such issues as quality of care, staff turnover, and occupancy rates. Of particular concern for Barry was the need for additional facilities for the post-World War II generation now reaching retirement age. Committee members also reviewed Medicaid reimbursement rates and compared them to the actual cost of running a nursing home.

Barry and the Interim Committee succeeded in improving reimbursement rates for long-term care in Missouri, despite the state's perennial budget crisis. Significantly, her support for fair payments for nursing homes does not appear to have denied her a reasonable chance of winning both the August primary and the November general election.

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In nearby Oklahoma, however, a candidate in the 2nd Congressional District Democratic primary has attacked her better-known opponent for his alleged ties to the nursing home industry. When Democratic Congressman Brad Carson announced that he would run for the U.S. Senate, the clear frontrunner to succeed him was first-term state legislator Dan Boren. Boren's father, David Boren, a former senator, is the author of the late, lamented "Boren Amendment" that required state reimbursement rates to reflect the real cost of operating nursing homes. Congress's repeal of the Boren Amendment a few years ago set the stage, in the minds of many long-term care observers, for today's looming Medicaid reimbursement crisis. Dan Boren is supported by most of Oklahoma's state Democratic leaders, while his strong support for tort reform earned him the endorsement of BIPAC, a national pro-business political action committee.

Throughout the year, however, former district attorney Kalyn Free has been cutting into Boren's lead. She has described Boren as a "carpetbagger" who recently moved to eastern Oklahoma to run for the vacant seat. More to the point, she has also attacked him for accepting campaign funds from long-term care providers, whom she describes as a "wealthy special interest." At a recent rally she said, "When Dan Boren votes to cut a program that allows seniors to stay in their homes longer while he takes money from the nursing home industry, I disagree with all those who say he's in the pocket of big business. It's not his fault, he just doesn't understand. He figures seniors go to posh retirement villages."

While the line was good for a laugh, it seems likely that Boren will eventually point out that the son of the author of the Boren Amendment isn't clueless about long-term care's needs, and that the nursing home interests his father supported are by and large contributing to Dan Boren from the relatively limited pocketbooks of not-for-profit providers and small family-owned facilities.

Nursing home bed supply emerged as a key issue in the Republican primary contest to succeed GOP incumbent Patrick Toomey in Pennsylvania's 15th Congressional District. State Sen. Charles Dent claimed that his more conservative rival, Joseph Pascuzzo, MD, had considered using his authority as a county commissioner to close a county-operated nursing home. Dr. Pascuzzo denied this, referring to published statements in which he demanded only a needs assessment to evaluate "the optimal number and type of beds" (although Dr. Pascuzzo was also on record for complaining that the county facility was "losing money"). Dent scored a landslide victory to win the Republican nomination.

A serious discussion of general healthcare financing was provided during the Illinois primary by David Gill, MD, an emergency medicine physician who serves as president of the Board of Directors of Dr. John Warner Hospital in Clinton, Illinois. Dr. Gill also serves as director of the men's social club at DeWitt County Nursing Home. Dr. Gill declared that he sought the Democratic nomination for Illinois' 15th Congressional District primarily because of his interest in healthcare financing reform, noting:

  I have advocated tirelessly for implementation of a tax-based
  single-payer universal national health insurance program. This would
  be both compassionate and fiscally conservative, with the General
  Accounting Office and the Congressional Budget Office estimating
  savings of $150 billion per year. But Washington does nothing to
  address this crisis. I have finally concluded that the only way to
  implement this "commonsense" type of program is to change the
  personnel in Washington; this is why I am running for Congress.

Dr. Gill strongly opposes the recent Medicare prescription drug benefit, describing it as "another distracting 'patchwork' keeping us from moving on with a desperately needed national health insurance plan." He is especially opposed to the legislative provision forbidding the federal government from negotiating for lower prices for pharmaceuticals, noting this has added to the costs of care for the Department of Defense and the Veterans Administration.

Dr. Gill is one candidate who succeeded in winning his party's nomination because of his positions on healthcare--a story that would be more interesting if he had a plausible chance of winning the general election. His popular GOP opponent, incumbent Congressman Timothy V. Johnson, won two-thirds of the vote in 2002. It seems unlikely Dr. Gill will be able to put his long-term care experience and passion for healthcare reform to work where they're needed--in Washington, D.C.--anytime soon.

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