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Congress urged to give long-term care higher priority.

The American Association of Homes for the Aging (AAHA) has urged Congress to assign long-term care financing a higher priority on the Nation's health care reform agenda.

Testifying before the Senate Finance Committee's Subcommittee on Medicare and Long-term Care, AAHA President Sheldon Goldberg said that, until the Senate hearing and the recent introduction of the Long-Term Care Family Protection Act, long-term care financing had been largely missing from the health care reform debate. "Yet," he said, "long-term care is the single greatest financial risk most older Americans and their families will ever face."

Not many older people can afford to pay $30,000 a year out of pocket for nursing home care, Goldberg said, especially when the median income is only $22,000 a year for families headed by older persons and $9,500 for older people living alone. Health reform, he said, "must address how to assist older Americans and their families in meeting the catastrophic costs of long-term care" without first spending themselves into poverty.

"AAHA has long believed that those who can afford to finance their own care should do so, conserving scarce public resources for the truly needy," Goldberg said. "If fewer people spent down to Medicaid eligibility, the severe strain on federal and state Medicaid budgets could be eased."

National studies show that up to 40 percent of the 65 years of age or over population could afford a reasonable level of long-term care insurance now, Goldberg said. Insurance could be made affordable for a larger group, he said, through a combination of Federal tax incentives to promote insurance, enactment of a catastrophic long-term care benefit linked to Medicare, and public education. As a result, consumers would come to view private long-term care insurance as a necessary extension of their Medicare and Medicare supplement (medigap) coverage.

Commenting on specifics of the Long-term Care Family Protection Act, Goldberg said, "AAHA supports the bill's proposed tax incentives to promote private long-term care insurance and has long advocated the consumer protection

standards for insurance the bill suggests. AAHA applauds the legislation's efforts to ensure access to a wide array of long-term care services, such as home health care, adult day care and respite care, as well as nursing home care." The association also favors provisions that would make it harder for people of means to shelter substantial assets in order to shift the cost of their care to Medicaid.

However, AAHA thinks the legislation's eligibility criteria may be so strict that individuals would not qualify for benefits until they were disabled to the point of needing nursing home care. "Allowing people to have access to long-term care benefits and supportive services at an earlier stage of disability, while still living at home or in specialized senior housing, could help them stay independent longer and avoid premature nursing home admission at high cost" Goldberg said.

The coalition agreed to collaborate on educating consumers, especially families of nursing home residents, about the importance of reducing restraints in terms of resident dignity and self-respect. Providers on the coalition said that their staff often encounter resistance from families when they try to reduce restraint use, because family members fear that falls and injury will result if restraints are removed.

"Nursing home providers have an opportunity to show leadership in this area" said Lois Evans, a University of Pennsylvania School of Nursing associate professor and a coalition member. Evans, who has written extensively on restraint use, explained that hospitals and other providers that routinely use restraints need much education on reducing their use.

The American Association of Homes for the Aging, which convened the Leadership Coalition on Restraint Reduction, recently published a white paper titled, The Use of Restraints in Long-Term Care. The Ethical Issues to provoke discussion of when, if ever, restraint use is appropriate. Copies are available for $5 from AAHA Publications, 901 E Street NW, Suite 500, Washington, DC. 20004-2037.

AAHA is the national non-profit organization representing more than 4,000 not-for-profit nursing homes, continuing care retirement communities, senior housing facilities, and community service agencies for the elderly.
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Title Annotation:News Briefs; Recent Health Care Developments
Publication:Health Care Financing Review
Date:Jun 22, 1992
Previous Article:Status report on implementation of the home health agency prospective payments demonstration.
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