CPA recommends funding reform to support long-term care services


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Long-term services and support are essential for older Americans facing frailty, disability and other age-related complications, and the demand and cost of this care is expected to increase in the coming years. according to the ACP.

In a position paper published in Annals of Internal Medicine, Ryan Crowley, YSB, senior associate for health policy at the CPA, and his colleagues said the number of Americans ages 65 and older is expected to grow from 56 million in 2020 to 73 million in 2030, representing about 20% of the population of the United States.


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As the aging population grows, the need for long-term services and supports (LTSS) increases, which are usually provided in assisted living facilities or in the person’s home and include help with daily tasks such as eating, dress and wash. According to Crowley and his colleagues, more than half of people who reach the age of 65 will develop a disease requiring paying LTSS.

Along with demand, the cost of LTSS “is expected to rise significantly over the next few decades, but policymakers have struggled to develop ways to meet this need,” the authors wrote.

LTSS industry already faces challenges including labor shortages, ‘complex and fragmented’ coverage, quality issues and protecting patients and providers from COVID-19, CPA says .

“Over the past few decades, policy makers have sought ways to make it easier for people to access the LTSS at home and in their community rather than in nursing homes or other institutions; However, under Medicaid, states are required to provide institutional care, while home and community services are covered as a state option and many enrollees do not have access to these services. in a timely manner,” Crowley and his colleagues wrote.

Short-term nursing home stays resulting from acute illness are covered by Medicare, the authors explained, but enrollees who need additional LTSS “often spend their income and assets to obtain additional coverage through Medicaid”. Many people who need LTSS are not eligible for public coverage and therefore pay for services out of pocket or rely on others for care.

In response to these barriers to access, the CPA said the LTSS sector “needs to be strengthened to ensure that patients can maintain their quality of life and financial stability as they age” and that more needs to be done. be done to improve the LTSS.

The CPA offered several recommendations in this effort, the first being “a multi-pronged public-private sector approach to reforming LTSS funding.” According to the organization, this should include public and private entities developing “a national information campaign to develop LTSS literacy and educate the public about preparing for future LTSS needs.”

Other specifics of this recommendation include CPA support for:

  • a publicly funded universal catastrophic LTSS insurance program;
  • policies to ensure that initial private long-term care insurance (LTCI) is affordable, accessible and viable;
  • standardize insurance policies and policies allowing the sale of hybrid tariffs combining LTCI and other products and the optional use of retirement funds for LTCI; and
  • more funding and policy changes that expand home and community services through Medicaid and other programs.

The CPA listed four other recommendations:

  • Policymakers and employers should address labor shortages in the LTSS sector by increasing wages and providing more benefits, comprehensive training, and career advancement opportunities.
  • Evidence-based interventions should be incorporated to improve the quality of the LTSS, such as “rigorous monitoring, enforcement of reporting and quality improvement requirements” and “research and implementation”. implementing emerging alternatives to institutional care”.
  • Research efforts should focus on the impact that ownership status has on the SLT sector, including staff and patient safety, staffing ratios, cost and quality of care.
  • Additional funding, staff support and assistance should be provided to LTSS organizations so that they can implement emergency preparedness plans to better ensure patient and staff safety while taking into account “the behavioral and social well-being of patients and staff…to prevent unintended consequences, including depression and loneliness.

About Antoine L. Cassell

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