March 1, 2013 — In the wake of the January 2013 repeal of the Community Living Assistance Services and Supports (CLASS) Act, Congress legislated the formation of a bi-partisan Commission on Long-Term Care to develop a plan to make long-term care services available to elderly individuals, individuals with substantial cognitive or functional limitations, and other individuals who require assistance.
According to the National Clearinghouse for Long-Term Care Information, 70 percent of us will need long-term care services at some point during our lives after turning age 65. The cost of such care continues to increase, squeezing middle-class families.
The 2012 Met-Life survey of long-term care services reports the national average daily rate for a semi-private room in a nursing home is $222, up from $214 in 2011 (a 3.7 percent increase).
This report also finds that average assisted living costs have risen to $3,550 per month from $3,477 (a 2.1 percent increase).
Medicare and private health insurance do not generally help pay for such expenses. Other options to pay for assisted living and nursing home care are as discouraging. The purchase of increasingly costly long-term care insurance is not feasible for many, and it is increasingly difficult to qualify for Medicaid benefits. Moreover, government benefits programs remain biased in favor of institutionalization, in contrast to what the AARP reports are the preferences of 9 out of 10 persons to age in place at home. Family members can sometimes be left with the exhausting task of serving as caregivers at the peril of their own health and financial security. As an Elder Law attorney, I see on a daily basis the heartache families face with the many variations of the long-term care crisis.
Why the CLASS Act Failed
Congress attempted to address these problems when it enacted the CLASS Act as part of the Affordable Care Act. CLASS was intended to allow persons who voluntarily paid monthly premiums to receive modest cash payments to help pay for their long-term care services if needed later in life. Planners soon realized that CLASS was designed to do the impossible: offer excellent benefits at low cost to an unknown pool of voluntary participants. The Obama administration suspended development of the program in 2011. Recognizing the program would not work without modifications, Congress repealed CLASS in the American Taxpayer Relief Act of 2012 (ATRA). The ATRA, which delayed the fall from the “fiscal cliff,” was passed on New Years Day 2013 and signed into law the next day.
Recognizing that the provision of long-term services and supports remains an important problem, however, Congress established in the same legislation a 15-member, bi-partisan Commission on Long-Term Care to “develop a plan for the establishment, implementation, and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports…[for] elderly individuals, individuals with substantial cognitive or functional limitations, other individuals who require assistance…” Once formed, the commission is to submit a report within six months with recommendations for legislative or administrative action. The report will be introduced as a Senate bill if approved by a majority of the commission members.
The President and the minority and majority leaders of the House and the Senate will each appoint three commission members. This will result in six Republican appointments and nine Democratic appointments. All but the President’s three appointees have been named. Among the 12 individuals announced so far is Judy Stein, the Executive Director of the Center for Medicare Advocacy and Past President of NAELA.
Many Complex Challenges
Six months is a very short time to address such a complicated problem. Some will remember the “Pepper Commission” and its valiant effort to sort through the complexities of the gaping hole in our care for older and disabled individuals. Yet the persons appointed to the Commission on Long-Term Care embody experience and knowledge of the complexities and challenges involved. We hope that the commission report will:
• Recognize that our current system of provision of services and payment structure needs improvement;
• Seriously consider how to add fairness to the current system that, for example, pays for expensive heart bypass surgery but not care for victims of Alzheimer’s or Parkinson’s disease;
• Consider the serious ramifications of the move by many states to force all Medicaid long-term care beneficiaries into private managed care;
• Consider the roles government and the private sector can play in solving problems; and
• Offer meaningful proposals.
We wish the commission success. NAELA stands ready to be a resource for information and assistance to the commission as it engages in its important work.