Health Policy Proposal

Long-term Care

Long-term care takes into consideration a variety of services tailored towards meeting an individual’s health or personal care needs for a short or extended period. The services assist people who can longer perform their daily activities because of a chronic illness, mental disability, injury, or other health-related conditions, in a bid to help them live independently and ensure their safety (Harris-Kojetin, Sengupta & Park-Lee, 2013). Individuals requiring long-term care may receive these services in various setups such as at home from a family member or professional caregiver, in private nursing homes, or in institutions of public nursing homes. Save for the services received at home from a family member, all other services are paid, and regulated providers make a significant component of personal care expenditures.

Background

The United States, like several other developed countries around the world, is grappling with the challenge of a rapidly aging population, triggered by life expectancies. The population of resident population aged 65 years and above was estimated to be around 13 percent in 2010 from 9.9 percent in 1970 (Ortman, Velkoff & Hogan, 2014). By 2030, the report by Ortoman et al. estimates the percentage to rise by more than 20 percent. Along with old age, the elderly population also has unique health needs with a high prevalence of chronic diseases such as diabetes, stroke, heart diseases, and cognitive impairment such as dementia (Lunenfeld & Stratton, 2013). As expected, the specific health needs of the elderly people in the U.S. necessitated a paradigm shift from hospital-based care, towards long-term care in a nursing home or at the individual’s home with a caregiver. For the United States, a vast majority of the elderly people receives assistance in private homes and community-based institutions, and only a small percentage receive care from their families at home due to the unavailability of household members (Normandin & Bogenschneider, n.d). Unfortunately, for the seniors, these services come at a very high cost. For instance, in 2012, the total spending for long-term care was estimated to be around $219.9 billion, a figure that is projected to increase to around $346 billion by 2040 (National Health Policy Forum (2014) The Basics, 2015). As it is, a substantial amount of this figure was paid out of the pocket with a higher percentage going to private homes. A more worrying trend is the number of people who reach the age of 45 years without any financial preparation in case they ever need long-term care services. Research also shows that if the rate of savings is not increased and government programs remain weak, most people at the age of 65 and above will face serious problems needing long-term care services in the future. In fact, by 2030, most of these older adults will not be able to pay for basic expenditures and expenses for their stay in a nursing home or home care provider (Feng, Fennell & Tyler, 2011). In light of this, we propose a system of financing long-term care services in the U.S., considering that the existing private long-term care insurance policy has failed to fix the current problem. The proposal is to have a public insurance program with attached costs and policy procedures about long-term care coverage. Along with that, most patients covered by the Medicare program do not receive quality care services as compared to their counterparts in the private long-term care insurance services. The second proposal would be to ensure delivery of quality care to patients under Medicaid without increasing the cost.

Stakeholders

In this proposed public insurance program, the key players will be the government who will be at the forefront in ensuring the policy has been enacted into law. The second largest stakeholders are the people who will be contributing towards the insurance kit. These include the individuals paying the insurance premiums together with their family members. Depending on the method of income generation these people will either be paying for their insurance from their monthly salary or out of the pocket. The issue of payment method brings in a third stakeholder who is the employer. The employer will be required to deduct the agreed amount and remit it to the insurance.

Issue Statement or Statement of Clarity

Private long-term insurance policies have been around for a very long time, but they have not been able to address the middle level and low-income earners. The plan seeks to present a bill where for a public insurance program available to all long-term residents in the United States that will rely on broad-based tax.

Possible Methods of Addressing the Issue

Currently, apart from private long-term care insurance policies and out of pocket payments, the other option older people have to finance their nursing home care is Medicaid or Medicare. The program caters for elderly individuals who cannot afford to pay for their stay in long-term care institutions (“paying for long-term care,” n.d). Unfortunately, Medicaid and Medicare are grappling with financial constraints as healthcare costs and demand increases (“Key Issues Facing the program,” 2014). With the flood of the new baby boomers, Medicare costs are expected to blow out of proportion. Besides, they have also initiated massive reforms on eligibility criteria in an attempt to curb fraud and cut down on provider payments, which leaves the option of relying on Medicaid out. The idea is to create a universal long-term care insurance program that would benefit even the middle level and low-income earners. Since the program would rely on broad-based tax, the government would be required to increase the tax to meet the growing burden. The other thing, it is widely assumed that fee-for-service health care guarantees the patients the widest choice of caregivers and exceptional access to quality care. Since the money paid by Medicaid is substantially small as compared to those paid by private insurers, the government should address this issue by implementing a mandatory managed care for long-term care patients. This would ensure that patients under Medicaid still receive better medical services as the government looks for other practical ways.

Goals and Options for Changes

1. To promote access to long-term care services to citizens of all levels by implementing a universal long-term care insurance policy
2. To promote continuity of quality care by introducing mandatory managed care for patients under Medicaid payment programs

Risk and Benefits of the Changes

Like in all other project proposals, reforming long-term care services has various risks and benefits. Firstly, once the policy has been enacted into law, people will be able to invest for their long-term care and reap the benefits in later years as the insurance policy will take care of their bills. This will be a huge financial relief for the individuals together with their families. For the proposal to be implemented successfully once it has been enacted into law, the tax will have to be increased to meet the increased financial demand. This is likely to cause tough economic times for the people who might be opposed to the policy in case they learn of the risks associated with it. In the implementation of managed care, there are also financial risks involved during the development of services and caregivers may not receive as much as they are used to getting but at increased services.

Evaluation Methodology

The evaluation methodology is a tool that helps in getting a better understanding of the necessary steps required in a quality assessment (Nkwake, 2015). In this case, due to increased cost of long-term care services and the growing population of seniors, the proposal seeks to implement a policy that would introduce a universal insurance program. Along with that, the proposal intends to focus on mandatory managed care for long-term care patients to improve care delivery. Thus, the purpose of the evaluation is to determine how universal insurance program on long-term care would be executed with the risks and benefits involved. The other purpose is to evaluate how mandatory managed care for long-term care patients under Medicaid can be implemented. Based on specific guidelines, the criteria to explain and exemplify the concept of demand and implementation will be adopted. After comprehensive evidence has been gathered, the next step will be to report and make the appropriate decisions.

Recommendation

In the United States, the current administration has been slow on the issue of affordable health care for the public (Haberman & Pear, 2017). The problem of the elderly has been neglected and left at the mercy of private long-term care insurance and Medicaid. By implementing these policies, the government would be sure to take care of the aging population as well as the issue of quality care in long-term care nursing homes. In fact, this would be a move towards providing affordable care, which is a necessity to the middle and low-level income earners. These people may not manage to purchase the overly rated insurance premiums or pay out of pocket, and this would be a great relief for them.

References

“Key Issues Facing the program.” (2014). United States Government Accountability Office. Retrieved from: http://www.gao.gov/assets/680/671761.pdf

“Paying for Long-Term Care.” (n.d). NIH Senior Health. Retrieved from: https://nihseniorhealth.gov/longtermcare/payingforlongtermcare/01.html

Feng, Z., Fennell, M. L., Tyler, D. A., Clark, M., & Mor, V. (2011). The Care Span: Growth of racial and ethnic minorities in US nursing homes driven by demographics and possible disparities in options. Health Affairs (Project Hope), 30(7), pp. 1358-1365.

Haberman, M., & Pear, R. (2017). Trump Tells Congress to Repeal and Replace Health Care Law ‘Very Quickly.’ New York Times. Retrieved from: https://www.nytimes.com/2017/01/10/us/repeal-affordable-care-act-donald-trump.html?mcubz=2&_r=0

Harris-Kojetin, L., Sengupta, M., Park-Lee, E., & Valverde, R. (2013). Long-Term Care Services in the United States: 2013 Overview. Vital & Health Statistics. Series 3, Analytical and Epidemiological Studies, 37, pp. 1-107.

Lunenfeld, B., & Stratton, P. (2013). The clinical consequences of an aging world and preventive strategies. Best Practice & Research Clinical Obstetrics & Gynaecology, 27(5), pp. 643-659.

National Health Policy Forum (2014). National Spending for Long-Term Services and Supports. The George Washington University. Retrieved from http://www.nhpf.org/library/the-basics/Basics_LTSS_03-27-14.pdf

Nkwake, A. M. (2015). Credibility, validity, and assumptions in program evaluation methodology. Cham: Springer.

Normandin, H., & Bogenschneider, K. (n.d). A Policymaker’s Guide to Long-Term Care in Wisconsin: Public, Private, and Family Perspectives. Policy Institute for Family Impact Seminars. Retrieved from: https://www.purdue.edu/hhs/hdfs/fii/wp-content/uploads/2015/06/fia_brchapter_23c01.pdf

Ortman, J. M., Velkoff, V. A., Hogan, H., & United States. (2014). An aging nation: The older population in the United States. Washington, DC : United States Census Bureau, Economics and Statistics Administration, U.S. Department of Commerce.