Legislative Help for Long-Term Care?

The SCAN Foundation today released results of a survey on long-term care readiness in California. It wasn’t pretty:

    • Roughly half of the poll respondents said they will need long-term care for a close family member within the next five years.

    • About half of the poll respondents said they cannot afford even one month of nursing home care.

    • Almost two-thirds of the registered voters in the poll said they’re worried about being able to afford long-term care.

    • A whopping 88% of those polled said legislators should make affordable long-term care a high or moderate priority.

“Among adult California voters, most folks have someone in their family who will need long-term care soon,” said Bruce Chernof, president and CEO of The SCAN Foundation. “But they are woefully unprepared for that. Most people cannot even afford more than three months’ worth of care. And that’s a big problem.”

The long-term care poll from The SCAN Foundation and the UCLA Center for Health Policy Research is in its third year.

There have been relatively few major legislative attempts to solve the long-term care problem in California, which is likely to intensify in the next decade as baby boomers hit Medicare age. Chernof said there are several reasons for the relative legislative indifference. Concern about the budget tops the list, he said.

“We’ve lurched from crisis to crisis with the budget deficit,” Chernof said. “The nature of those budget discussions has people’s rapt attention, so focusing on these long-term issues is more difficult. I also think solving this long-term care services and support question is hard. It will take time, it will take focus and it will take resources, which is tough because of the limited budget opportunities.”

Chernof said about 70 cents of every dollar spent on a vulnerable older person comes from the federal government. “So, little perturbations in funding [from federal sources] can have huge effects on state policy,” he said.

Chernof said the state is on the right track, despite the many cuts that have hit long-term care services.

“There are fundamentally only two ways to control health care costs. You can cut what you’re spending, or you actually have to transform the entire system of care,” Chernof said. “The most expedient is cutting the number of programs and services, but in the long run, we have to transform instead of just cutting.”

That’s the hope for California with implementation of the Coordinated Care Initiative, also known as the duals demonstration project, Chernof said.

“I do see the state trying to move in that direction,” Chernof said. “The duals project represents a big opportunity to improve long-term care in the community. Currently the right service is not necessarily delivered at the right time, by the right provider, to the right person. What it offers is to coordinate all of that care. If it is done well, I see it as a great opportunity.”

Chernof said “done well” is a crucial element of the duals program. “People are afraid this is purely a budget exercise,” Chernof said. “So it is a two-way street, we need to provide beneficiaries those protections.”

Legislatively, Chernof pointed to last session’s introduction of SB 1438 by Elaine Alquist (D-Santa Clara), which is currently held up in the Senate Committee on Appropriations. It would have created a task force to set up a state plan for addressing long-term care issues, and Chernof said that could be a good legislative start.

Doing nothing is not a choice, Chernof said. “If current processes continue to operate the way they do, they will swamp the programs that are currently available. The system is not built for the wave of boomers who are about to come through. We can either rebuild and transform, or we will find our resources completely stripped to handle what the boomers will need,” he said.  

It’s a critical and ultimately hopeful time for California, according to Chernof.

“As scary as all of this can sound, California is on the cusp of transforming its aging services, with developing a single, uniform assessment tool, global budgeting and reorganizing services,” he said. “I do believe that’s within our grasp. These budget problems give us an opportunity to look at the way we’re doing things, to reform the process.”