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Source: Avalere Health released with Kaiser Health News report – see below news story

Caregiver & Elder Care News

Need to Address Long-Term Care Demands Highlighted in Report by AARP, Others

States struggling with high demand and limited resources to provide non-Medicaid long-term services and supports

July 16, 2013 - A report highlighting the challenges facing states in providing long-term services and supports (LTSS) was released today, just as states begin to implement LTSS options in the Affordable Care Act that increase access to Medicaid home and community based services (HCBS).

Most states did not increase funding for non-Medicaid services – including senior centers, information and referral, transportation and caregiver supports, such as those under the Older Americans Act, according to the report by AARP Public Policy Institute, National Association of States United for Aging and Disabilities (NASUAD) and Health Management Associates (HMA).

As Americans age, the demand for long-term care, including home and community based services, only continues to grow; and it’s happening at a time when state budgets are still strapped.

The recent meeting of the federal Commission on Long-Term Care serves as a reminder that as a country we’re at the crossroads when it comes to providing care for older adults and persons with disabilities. (See report on this meeting below this news report.)


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The report examines findings of the third annual survey of LTSS systems across 49 states and the District of Columbia, highlighting transformations and reforms underway and trends across the country.

The report found that more states are increasing participation in HCBS options within the Affordable Care Act as well as initiatives for individuals who are dually eligible for Medicaid and Medicare. At the same time, they’re seeing increased demand for non-Medicaid services; for example, the caseload for adult protective services – for victims of abuse or exploitation – has increased in the last two years without increased funding in many states.

“It’s increasingly evident that we need to rethink how we address long-term services and supports in this country,” said Susan Reinhard, Senior Vice President for the AARP Public Policy Institute. “Long-term services and supports are critical not only to the population they serve, but also to the family caregivers who support them.”

“The decision by so many states to transform their Medicaid LTSS systems from fee-for-service to managed care ranks as the most significant byproduct of The Great Recession,” observed Martha Roherty, Executive Director of NASUAD. 

“But our report documents that other vital programs for seniors, reliant entirely on state revenues, still languish six years after the recession began. As their economies improve, states now must turn their attention to other state programs like Adult Protective Services, still struggling with reduced or flat funding, hiring freezes and staff reductions.”

“This report illustrates how states are actively engaged in exploring ways to better serve individuals with ongoing health care and support needs,” said Jenna Walls, senior consultant at HMA. “The overwhelming survey response rate indicates state policymakers are committed to advancing a national dialogue for how to best address the increasing demand for services.”

The new report, “At the Crossroads: Providing Long-Term Services and Supports at a Time of High Demand and Fiscal Constraint” is available here:

About AARP -

The National Association of States United for Aging and Disabilities (NASUAD) was founded in 1964 under the name National Association of State Units on Aging (NASUA).  In 2010, the organization changed its name to NASUAD in an effort to formally recognize the work that the state agencies were undertaking in the field of disability policy and advocacy.  Today, NASUAD represents the nation’s 56 state and territorial agencies on aging and disabilities and supports visionary state leadership, the advancement of state systems innovation and the articulation of national policies that support home and community based services for older adults and individuals with disabilities.

About Health Management Associates -


This report of the first meeting of the Long-Term Care Commission was reported by Kaiser Health News on June 28, 2013

Facing A Tight Deadline, Long-Term Care Panel Holds First Meeting

By Susan Jaffe, KHN

June 28, 2013 - The Commission on Long-Term Care held its first meeting Thursday on Capitol Hill with some members acknowledging that their late start adds to their challenges in offering Congress recommendations on how to finance the expensive services for seniors and disabled Americans. 

The panel is hobbled with a meager budget and staffing, and it is facing a three-month deadline for its report. Speakers at the meeting reminded the commission that the effort is daunting. 

The commission heard a litany of statistics from four experts who explained how the nation's growing population of seniors will become more dependent on long-term care services. But the rising cost of those services threatens to deplete individuals' savings and add to the nation's budget problems because of the expenses borne by Medicare and Medicaid. 

"We know that 70 percent of people over the age 65 will need some form of long-term services and support," said Dr. Bruce Chernof, the commission’s chairman who also heads the SCAN Foundation (which helps fund KHN's aging coverage), a research organization that focuses on elder care. 

Anne Tumlinson, senior vice president of the research firm Avalere Health, told the panel that nearly half of the Americans receiving long-term care are under the age of 65, with only a minority living in nursing homes. She estimated that total number of people getting long-term care will be 16.5 million in 2050, a 70 percent increase from today’s numbers. 

Medicare, the health care program for the elderly and disabled, does not cover unlimited nursing home care and restricts it to those have spent three in-patient days in a hospital. Medicaid, the joint federal-state health program for low-income people, covers more than 60 percent of the people living in nursing homes.

Although government programs provide a significant portion of long-term care, none offer the full range of services people need, said Kirsten Colello, a health and aging policy specialist at the Congressional Research Service. 

Using long-term care insurance to pay expenses is not an option for many Americans, as premiums rise and companies that can’t make a profit leave the market, said Marc Cohen, an industry consultant. Most of the long-term care policies available are sold by only 12 insurers, he said.

G. William Hoagland of the Bipartisan Policy Center offered the most dismal outlook for the commission. "Medicare and Medicaid have become the major source of long-term care, and cannot continue at the current pace," he said. Americans should be encouraged to increase their retirement savings so that these programs are relied on as a last resort. 

Congress established the panel as part of the Jan. 2 fiscal cliff deal. It took three months for congressional leaders and President Barack Obama to appoint the commission’s 15 members. Under the law, the panel’s recommendations are due to Congress six months after its members are appointed. But nearly three months passed before the commission finally convened. 

“We have a very short time line,” said Chernof. “There are a lot of things we would have liked to do as a commission, but we will be done by the end of September.” 

The last time Congress created a long-term care commission was in 1988, which became known as the Pepper Commission, named for its first chairman, Rep. Claude Pepper, D-Fla. That commission took two years to complete its work, and by then, Sen. Jay Rockefeller, D-W.Va., had taken over as chairman. 

"The fact is that each of us will need these services and supports at some point in our lifetimes," Rockefeller, who added the commission to the fiscal cliff compromise, said in a statement Thursday. "The question is whether most Americans can afford to pay for them."

At the meeting, the commission's vice chair, Mark Warshawsky, director of retirement research at the benefits consulting firm Towers Watson, seemed to acknowledge that the panel was trying to make up for lost time as he thanked the invited experts for appearing on very short notice. 

The commission was formed after the demise of the voluntary long-term care program created by the federal health law, called the Community Living Assistance Services and Supports Act, or CLASS. The Obama administration cancelled CLASS after determining that it was unfeasible because high premiums would discourage healthy people from joining. If enough people did not voluntarily enroll, the program would not have been self-sustaining. Congress later repealed CLASS and replaced it with the commission.

The group is sharply divided politically with nine members appointed by Democrats and six by Republicans.

"The commission should not be sold short, coming out of the gate," said Connie Garner, a top aide to the late Sen. Edward (Ted) Kennedy, D-Mass., who championed CLASS. "It is keeping the conversation alive." 

The commission is planning additional public meetings, although no dates have been set, said Chernof.

Contact Susan Jaffe at


Some of this information is reprinted from with permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery. © Henry J. Kaiser Family Foundation. All rights reserved.


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