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    Posted January 20, 2013 by
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    Fiscal Cliff Averted as Long-Term Care Ledge Looms


    As President Barack Obama prepares for his inauguration just after law makers have finally passed the budget agreement that promises to avert the so called "fiscal cliff," and following the start of the new budget year, the stage is set for significant and continuous change in long-term care for our nation's elders. As baby boomers enter retirement with average lifespans that extend far longer than previous generations, concerns continue to mount for who will foot the bill for those in need of care. While Medicare and Medicaid — two of the primary sources that pay for care of elders — may have missed the razor's edge of budget cuts within the current fiscal plan, the future of these critical programs remains uncomfortably close to a spiraling free-fall from "the long-term care ledge."


    To avert yet another threat, lawmakers have called for the White House to appoint a National Commission on Long-Term Care as part of the agreement signed into law on Jan. 2, 2013.  The job of the committee is 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 individuals in need of such services and supports an individual’s desiring to plan for future long-term care needs."

    Originally championed by Senator Jay Rockefeller (D) of West Virginia, the national commission must be charged with taking serious steps to avoid what could be a tragic fall in our nation's ability to care for our elders. Solutions that will finally answer how to pay the bills while also providing quality medical treatment and long-term care for our seniors— at a time when most needed — must be realized if we are to step away from the shaky ledge.

    At risk is an unprecedented increase in the cost of care that will be created by too much focus on cutting costs and not enough preparation for affording the quality of care that will be needed. Healthcare providers and home health agencies will undoubtedly be faced with reduced reimbursements while sick and disabled elders will pay the ultimate price: lack of quality care. Home health and personal care services agencies provide a formidable solution but appropriate remunerations that empower quality care are essential.

    History has shown that inadequate treatment and lack of patient and family caregiver education and engagement results in re-hospitalization; hence, the readmission penalties included in the Patient Protection and Affordable Care Act. The fiscal business of providing care for our seniors must pay for a comprehensive care plan that not only ensures the sick receive quality care during hospitalization and in acute-care settings, but also that adequate reimbursement for skilled nursing, home health and hospice care services is provided. A heavy dose of patient and family caregiver education and engagement is also essential and is best served in the home health setting. Failure to provide a holistic approach will likely result in an unprecedented increase in the future need for long-term and home health care services. Readmission and/or the need for related treatments will create a self-fulfilling repetitive cycle resulting in an overall increasing cost of care.

    As the business of healthcare continues its focus towards cost saving models, patients will find themselves thrust into the driver's seat of a broken healthcare system that is already on the ledge. Family caregivers, now more than ever, will be called upon to provide the majority of care for their elder relatives. The burdens to coordinate, oversee and provide basic at home care will be significant for already busy relatives. This, while also attending to the demand of significant others, children, community and career will set into motion exponential stressors, the seeds from which will sprout  future illness, burnout and depression thus thrusting the caregivers themselves into a position of need for care. Demands of a busy caregiver's schedule will result in unhealthy lifestyle choices thus increasing risks of health related illness. A generationally repetitive cycle of burden upon the already failing health care system will emerge. The need has never been greater for home health and personal care services agencies to reduce the risk of the additional burden. The national committee will hopefully recognize that old paradigms in home health reimbursement have already driven home health and skilled nursing facilities off the fiscal cliff saved only by a long-term care ledge that is precariously weak.

    As the long-term health commission takes shape in the midst of the healthcare sector's historic transformation, the future of Medicare and Medicaid coverage for medical treatment, home health, skilled nursing and hospice care for the elder population remains in the balance. Teeter-tottering on the slippery ledge are measures that must account for both quality and sustainability of the long-term care needs of our nation's elders. The commission will have its work cut out for it as it seeks to fix the broken finance system as part of the near-term fiscal cliff without unwittingly creating a catastrophic dive from the long-term care ledge.

    If Senator Rockefeller is right, "By the year 2030, there will be 72 million people aged 65 years or older in America — more than twice the number today — with those aged 85 years and older becoming the fastest growing segment of the population. Most of these individuals will lack the retirement and income security necessary to meet their long-term care needs and could face impoverishment instead of the dignity and peace of mind they have worked for their entire lives."

    While Senator Rockefeller's efforts to bring focus to the looming crises in caring for the nation's elders are commendable, more must be done. Perhaps the recent efforts to avert the fiscal cliff by appointing a commission will prove a step in the right direction to avoid a tragic fall from the long-term care ledge. Respectable reimbursement for home care, hospice and skilled nursing services combined with special attention to patient and family caregiver education and engagement are essential and are hopefully among the first order of business to be addressed by the commission.

    About the Author: Harlon J. Wilson, M.S. is a health information technology executive, “imagineer” and award-winning entrepreneur.  Driven by a passion for health IT innovations that educate, empower, and engage healthcare consumers Harlon currently serves as the Chief Innovation and HIPAA Compliance Officer for CareGivers, Inc. where he pursues innovative technology solutions, partnerships and collaborations that aim to reduce the costs and improve the quality of home health and personal care service delivery. Business savvy, Harlon builds health IT companies, products, and services from start-up to acquisition. He is a visionary strategist skilled in converting complex health, life sciences and IT concepts into innovative strategies, products and solutions.

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