Defense Is Great, But Without a Strong Offense We Won’t Reach the Goal Line in Addressing Long-Term Care Needs

Over the past 15 years, I’ve had the pleasure of officiating college football games. With my professional life outside of football becoming more demanding, I “retired” last year. But officiating taught me a number of life lessons that can be applied in other ways.

For example, on the occasions I had the great fortune of officiating conference championship games, I observed the difference between champions and runners-up. It’s been said that “defense wins championships,” but in my observations a balance of a strong offense and defense actually wins championships.

I’d argue that this can apply not only on the football field but also to the field I work in, services for older adults. And the time has come for the business of aging services – and the public, as well – to tackle the need for universal long-term care for older Americans.

It’s time to play offense.

Let’s clear up some misconceptions

For far too long, providers and consumers have played defense by either complacently accepting public policy that has been handed them, accepting the status quo or actively fighting for their financial lives in the face of reductions in funding.

So I want to start here, by simply expressing my views on the state of long-term care needs of America’s older adults and thoughts on bold ideas to better address those needs.

True to my Public Health training at the University of North Carolina, I believe access to quality, long-term care is a right – plain and simple. I’m not here to debate the acute care side of things and what’s covered or not, but I am sounding an alarm that access to long-term care is in peril!

First, let’s clear up some misconceptions. When it was established, Medicaid was not intended to be the de facto long-term care payor/insurer for older Americans. It was designed as a preventative health care program for single women/mothers, children and others impoverished through no fault of their own.  As the nation grew older, and older adults began spending what little, if any, resources they had on their own care, the fallback program was Medicaid.

Today long-term institutional care makes up the largest percentage of the Medicaid budget. It’s pretty clear down the road that Medicaid will not provide Americans the coverage it once did, even without the threatened funding cuts from Congress and the current Administration.

Simply, we as a nation are ill-prepared for the onslaught of more and more older adults in coming years. Just this week I read in The Wall Street Journal that there are 491 people per hour turning 60 years of age – that’s 11,784 people a day! If we are struggling to cover costs today, think of what tomorrow holds when these individuals need care. Surely, we can proactively develop a better program that doesn’t require older Americans to impoverish themselves before they even qualify for access and eventual assistance with daily care.

Second, let me further differentiate between basic medical care and the special care needed by older adults. Medical care focuses on illness and curing disease. Long-term care and support, however, addresses functionality from a holistic approach – basic daily rituals such as cooking, bathing, moving around and taking medicines. And yet for the typical older adult, these two types of care needs coexist, along with the help required from loved ones and friends.

As our aging population grows by leaps and bounds and social services and assistance are strained and falter, how do we provide older adults access to the broad scope of care services they require?

A bold plan that makes sense

LeadingAge, the national member association representing more than 6,000 organizations dedicated to providing care services for older adults, has proposed a plan (a disclaimer here – I’m the incoming chair of LeadingAge). This plan revolves around a universal insurance program to cover the long-term services and supports of older adults and features three general principles:

  • A universal approach to coverage: The mandatory program would spread risk over a large population, thus lowering expenses for individuals, and increasing overall funding for long-term services and support.
  • A catastrophic benefit period: The program would finance care for individuals with high needs for this care and support. Benefits would begin after individuals had financed their own care for two years through private long-term care insurance or out-of-pocket spending.
  • A “managed cash” benefit structure: Beneficiaries would use a cash payment to purchase services and supports related to a long-term care need. This flexible approach would ensure that services and supports were tailored to individual needs and preferences.

LeadingAge is on to something here – it’s called playing offense. It is high time that providers, backed by consumers’ desires, push a program up from the bottom, rather than it coming from the top down and putting everyone on the defensive.

We know from claims data that 70 percent of Americans over the age of 65 will require access to some form of long-term service or support. Such a high likelihood of usage demands an umbrella of coverage which cannot, and is not, being met in the free marketplace. The number of carriers offering long-term care insurance to individuals has diminished precipitously over the last 10 years. In addition, long-term care insurance premiums have risen to the point that in many cases, only individuals with enough financial resources to actually self-fund their long-term care can afford the premiums.

How backwards is that?

Averting a recipe for crisis

I believe in the American dream, and I believe that most Americans in pursuit of that dream are comfortable contributing to a program that provides long-term catastrophic coverage, universally.

This, folks, is the direction I believe the country must head in order to address the exponentially growing needs of more and more older adults. We need to shift our expectations of antiquated programs such as Medicaid and look at creating a universal insurance program to support long-term care for older adults.  Playing defense is wearing everyone out except the politicians!  The status quo is a recipe for eventual crisis, and cutting what is already inadequate funding is a guarantee for near-term collapse.

There must be a better way.

But a change in direction of this magnitude cannot come about by being reactionary. As I said earlier, championships are won by having a balanced attack, which must include a strong offense – in this case a bold, fair, balanced plan backed by proponents who are willing to work to “get the ball over the goal line.” I challenge not only my colleagues in aging services to get on board with this effort, but also the general public. Americans must begin to learn more about this issue – which ultimately impacts each and every one of us – and hold their elected representatives accountable to get engaged, too.

Our collective long-term care needs and the nation’s fiscal well-being depend on it!

Dear Elected Officials: Thank You . . . And
January 15, 2018
An Open Letter to Lawmakers: Seems Like A Recipe for Disaster, To Me
December 11, 2017
‘It’s Our Time to Change the Way America Ages’
October 30, 2017
  • Reply
    Ken Keeton
    August 4, 2017 at 3:49 pm

    An excellent post, Steve. As a caregiver for elderly parents, I agree with you on many levels. Thank you for broaching an important topic that many would rather not discuss. Delighted to read about LeadingAge’s plan and efforts, too. Glimmers of hope.

  • Reply
    Pam Barrett
    August 21, 2017 at 6:27 pm

    Excellent insights Steve! I look forward to following your blog and congratulations to LeadingAge on having your leadership. On Sept 1st, my twin and I will become two of the 11,784 boomers turning 60 on that one day!

    A career in Hospice has taught me many things including the critical need for discussing issues of aging and advance care planning. We must create safe spaces to be proactive and create offensive strategies as you describe.

    I believe that Healthcare insurance, including quality long-term care benefits must become accessible. Universal coverage for the right care at the right time and in the right place will save dollars and make sense over time. I’m an optimist! Keep up the good work!

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