Running head: LONG TERM CARE FINANCING POLICY 1

Long Term Care Financing Policy Formation

Christine Davis

Delaware Technical Community College

NUR 420 Nursing Policy

Susan Lewis

October 6, 2019
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The Aging Population and Long-Term Care Financial Problems

“The United States population is aging with the number of adults aged 65 and older

projected to almost double between 2012 and 2060, from 43.1 million to 92 million” (Mason,

Gardner, Outlaw & O’Grady, 2016). According to Gabriel (2018) “the number of older

Americans is growing at an accelerating pace and will continue.” According to the United States

Department of Health and Social Services (DHSS) (2017), “70% of the United States citizens

that reach the age of 65 will at some point need long term care.” “Nurses should act not only

because of a concern for all those individuals who need long-term services and support (LTSS)

but also to ensure that they, their families, their friends will all have access to high-quality,

appropriate LTSS in the future” (Brokaw, 2016). An article that was written in 1985 by

Mechanic still holds true today, 35 years later “as more of the population enters the ages

associated with disability and dependence, our failure to develop a coherent policy of long-term

care that protects the elderly and their families at the period of greatest vulnerability will increase

and become a more explosive social issue.”

It’s likely, not a matter if you’ll need long-term care, it’s a matter of when (Long-Term

Care: Not IF but When, 2017). According to the Journal of Financial Planning written by Dorn,

Sharpe, Dickey and Herring (2017) one in four 65-year-old Americans will live to be older than

90 and one in ten will live to be older than 95. “As the older population continues to grow in

number and live longer, the adequacy of private and public funding for long-term care expenses

will become a greater concern” (Dorn, Sharpe, Dickey & Herring, 2017). “According to DHSS,

less than 1/3 of Americans 50 years or older have begun to save for long-term care” (Huddleston,

2017).
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The nursing home costs in the United States had a rise in cost from $85 billion to $143

billion from the years 2000 to 2010 (Mason, Gardner, Outlaw & O’Grady, 2016). “Medicare and

Medicaid, the two largest sources of primary/acute (Medicare) and LTSS (Medicaid) healthcare

financing for individuals who need LTSS, have historically failed to coordinate effectively to

prevent or delay the need for LTSS, or to best ensure that individuals receive LTSS in the most

cost-effective setting” (Edwards & Sans, 2019). According to Lumby, Browning and Finke

(2017) “Long-term care (LTC) services are not covered under most existing insurance plans and

private health insurance rarely covers any type of LTC-related expenses.” “Medicare does not

pay for custodial care or assistance with activities of daily living (ADLs), the Medicaid program

is the primary payer of LTC expenditures in America” (Lumby, Browning & Finke, 2017).

“Medicaid eligibility requirements impose strict income and asset limitations, as a result, a large

percentage of middle-class Americans have difficulty qualifying without a significant depletion

of wealth” (Lumby, Browning & Finke, 2017). A study done by AARP discovered that in every

state LTSS is not affordable for middle class families (Seigel & Rimsky, 2015).

In the past 20 years baby boomers have given care to a family member, and 90% to 95%

of aging adults rely on family for care (Siegel & Rimsky, 2015). The Affordable Care Act

(ACA) does not provide as much support for caregivers as was expected or is needed, however

the plan provides a platform to launch additional policy initiatives to aide caregivers (Brokaw,

2016). “Nearly 3 million individuals who need assistance with three or more activities of daily

living do not live in nursing homes, most of these individuals have at least one family caregiver,

unfortunately, this trend will not continue” (Seigel & Rimsky, 2015). Seigel and Rimsky (2015)

say that in 2015 there are 7 potential care givers per aging adult and will be less than 3 by 2050.
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“Political efforts are needed at the local, state, and national level, nurses and nursing

organizations are needed to form joint alliances with consumer organizations to advocate for

needed changes in the long-term care system” (Mason, Gardner, Outlaw & O’Grady, 2016).

“The proverbial elephant in the room: Aging in place cannot become a reality without

integrating affordable long-term care services” (Siegel & Rimsky, 2015). “Thereby increasing

the importance of understanding the dynamics of long-term care insurance ownership” (Dorn,

Sharpe, Dickey & Herring, 2017).

Key Stakeholders

The number one stakeholder in long-term care is the patient, who deserves quality care at

an affordable cost. The family members/loved ones also are stakeholders due to them possibly

being the ones to care for their loved one in their time of need, and they deserve to be paid for

the services that they are providing.

Nurses, administrators, doctors, aides are stakeholder for they are supplying the care, and

see the repercussions of insurances in long-term care. “Legislators like to work with groups that

have a strong position on a bill like the American Nurses Association” (Mason, Gardner, Outlaw

& O’Grady, 2016).

The owners of the facilities, their state rating will allow people to shop for a quality care

facility, the better the rating, people will trust to have their loved one in the facility.

Delaware’s Director of Medicaid and Medical Assistance, Stephen Groff, head of Policy

Planning Glyne Williams and Long-Term Care Eligibility and Services Staci Marvel. Medicaid is

a federal-state program that is the largest payer of LTSS, it pays for 45% to 65% of LTSS in the

United States (DHSS, 2019).

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Representative from Medicare, a federally funded insurance coverage for citizens aged 65

and older or have a disability. Medicare does not fund LTSS, as a working citizen the money

placed in that fund should not have any stipulations on where the money goes.

I would invite Senators in Congress of the United States, both representatives of the

House and Senate. The sponsor that I would choose would have already passed long-term care

bills, and/or voted for change in LTSS. “A bill can come from anyone but only Members of

Congress can introduce a bill in Congress, bills can be introduced at any time the House is in

session” (Mason, Gardner, Outlaw & O’Grady, 2016).

Current or Pending Laws and or Proposals

Congress passed the Recognize, Assist, Support and Engage (RAISE) Family Caregivers

Act in January of 2018 and was signed by the President on January 22, 2018. This important

bipartisan bill will help ensure that communities, providers, government, and others recognize

and support the more than 40 million family caregivers in America (AARP, 2018).

Washington state passed House Bill 1087, Public Long-Term Care Insurance, which in

2022 working citizens of Washington will be able to put money into a trust fund for use of long-

term care services, payment to caregivers, respite, or anything needed in the home to

accommodate the older adult (Bunis, 2019).

S.1351: Americans giving care to elders (AGE) Act of 2019, was introduced on May 7,

2019 and is in the first stage of the legislature process (Govtrack, 2019). This bill is to amend the

Internal Revenue Code of 1986 to “provide an income tax credit for eldercare expenses, adult

day services, personal care and respite care” (Govtrack, 2019).

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Lobbying for My Cause

Research

I have compassion on this topic, I have seen a lot of wrong when it comes to financing

long-term care, I have seen more devastation and desperation in the eyes of patients and loved

ones, and that is a good thing to start a good fight. Research will be on statistics and firsthand

experiences from families and loved ones. I will educate myself on the elected officials that I

choose to speak with. I will familiarize myself with bills that are pending and ones that have

already passed. If I need more guidance, I will “contact government agencies for a more detailed

document, that could include bill texts and summaries, federal agency reports and studies, and

could offer countless sources of federal data online” (Mason, Gardner, Outlaw & O’Grady,

2016).

Identifying supporters

My identifying supporters would be members of Congress or my state Legislator who

have experiences and vote on LTSS. I will continue to educate myself on the political aspect of

getting a policy/bill passed. I would take interest in Senators voting record in passing bills that

involve LTSS. I will need to contact the Senators that have already had a policy/bill passed under

their sponsorship. I will need to find out who their expert staff members were in order to see how

they were briefed with information on a specific policy/bill (Mason, Gardner, Outlaw &

O’Grady, 2016).

Building relationships
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The importance of building relationships with political staff by getting involved in a

political party, attend local and state meetings and or committee meetings (Mason, Gardner,

Outlaw & O’Grady, 2016). Building a relationship with the political staff can lead me in the right

direction to find sponsors for my cause (Mason, Gardner, Outlaw & O’Grady, 2016). Having a

trusting relationship with families and patients can spread the word gaining more support from

people that I haven’t even met.

How I would lobby for my cause

Lobbying is an attempt to shape policy and influence government by ensuring that key

policy makers are aware of and understand the concerns of constituents (Mason, Gardner,

Outlaw & O’Grady, 2016). I would arrange for a personal visit. I am very old school and I feel I

would be the most effective by meeting in person. Body language, the passion and or anger in

my voice will assist me getting the politicians to understand the dire need to assist our aging

adults. I would provide testimony from patients and family members that have had experience in

how devastating long-term care financing was on them. I would provide information on how

well HB 1087 is doing in Washington State. Having a coalition there to support me will show

legislators that I have a united front on the issue that I am asking them to change for better

financing of LTSS.

Talking Points

“If policymakers want to shift Medicaid’s future LTC responsibilities to the private

sector, one very simple solution: better educate Americans about the risks, costs, and needs

associated with long-term care” (Lumby, Browning & Finke, 2017).

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 I have witnessed patients getting rid of lifelong savings to receive Medicaid, you
are only allowed to have $2,000 in assets to qualify. Increase nursing home
financial accountability, by capping profits and administrative costs (Mason,
Gardner, Outlaw & O’Grady, 2016).

 “Have Medicare offer 14 days of respite care coverage to give a break to the
person that is caring for the patient” (Eisenberg, 2017).

 Provide a family caregiver tax credit (Eisenberg, 2017). Statistics show that it is
cheaper to have family/visiting nurses or aides provide care in the home than to be
placed in a long-term facility

 Give incentives at work to offer affordable long-term care insurance “Long term
care insurance can protect your savings, preserve your independence, and help
you maintain a better quality of life and since long-term care can be very
expensive, insurance is the best way to cover these costs without having to resort
to liquidating other assets” (Consumer Advocate, 2019).

 “Some countries have mandatory public long-term insurance, that can serve as a
model for the US, the nation should focus on public financing of LTSS insurance
that would ensure that all citizens have access to high-quality care” (Mason,
Gardner, Outlaw & O’Grady, 2016).

My Goals

My goal would be to get the word out by starting with a coalition of nurses, the families

that have been affected by the lack of long-term care financing, and patients. Being involved in a

group that has the same interest as you do will be recognized as a strong force for the cause.

Another goal would be to get a Senator to sponsor and multiple to co-sponsor my bill. Having

sponsors will help with getting other representatives to support the bill.

Actions taken

Going to long-term facilities to get petitions signed by administration, family, loved ones

and nurses. Going to state political meetings, to build a relationship with local and state level

politicians. Educate as much as I can on the importance of having some type of coverage for

long-term care in the future by reaching out to young working adults. Talking to Senator Jay
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Inslee and AARP’s representative that assisted in Washington getting the bill passed, to assist in

a starting point for me. Getting assistance in building a web page to put the word out on the

importance of having financial LTSS coverage. Getting a meeting with Delaware Senior

Legislative Analyst, Victoria Brennan, who serves on Delaware’s Health Care Commission

(Delaware General Assembly, 2019).

Accomplishments

My accomplishments would be to have a sponsor and some cosponsors to support this

bill and introduce it to legislation. Educating as many people that I can and have them sign a

petition to pass this bill. To have a large coalition that would stand in front of congress and push

for something to be done to help our aging adults. As a nurse we are the most trusted profession

and I would use that to the greatest extent to get people to listen to me on why this bill needs to

be passed. Any start in congress to change how this country is paying for long-term care services

would be an accomplishment for me as a nurse, everyone in this world deserves high quality

care, no matter the expense.

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References

Association of American Retired Persons. (2018). Thanks for being a champion for family

caregivers! AARP. Retrieved from

https://action.aarp.org/site/Advocacy?cmd=display&page=UserAction&id=6856

Brokaw, J. (2016, September 22). The nursing profession’s potential impact on policy and

politics. American Nurse Today. Retrieved from

https://www.americannursetoday.com/blog/nursing-professions-potential-impact-policy-

politics/

Bunis, D. (2019, May 19). Washington State enacts public long-term care insurance. AARP.

Retrieved from https://www.aarp.org/politics-society/advocacy/info-2019/washington-

long-term-care-law.html

Consumer Advocates. (2019, September 26). Best long-term care insurance based on in-depth

reviews. Retrieved from https://www.consumersadvocate.org/long-term-care-insurance

Delaware General Assembly. (2019). Analyst Assignments. Delaware General Assembly.

Retrieved from https://legis.delaware.gov/Offices/ControllerGeneral/Analysts

Department of Health and Human Services (2017). How much care will you need? U.S.

Department of Health and Human Services. Retrieved from

https://longtermcare.acl.gov/the-basics/how-much-care-will-you-need.html

Dorn, M. E., Sharp, D. L., Dickey, G., & Herring, D. D. (2017). Understanding the Determinants

of a Long-Term Care Insurance Purchase. Journal of Financial Planning, 30(11), 38–45.

Retrieved from
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http://search.ebscohost.com.libproxy.dtcc.edu/login.aspx?direct=true&db=bth&AN=126

078331&site=ehost-live

Edwards, B. C., & Sen, A. P. (2019). High Demand and Fragmentation: The Current State of

Long-Term Services and Supports in America. Generations, 43(1), 20. Retrieved from

http://search.ebscohost.com.libproxy.dtcc.edu/login.aspx?direct=true&db=f5h&AN=136

062896&site=ehost-live

Eisenberg, R. (2017, July 12). How to keep long-term care from bankrupting us: Fresh ideas

from a new Bipartisan Policy Center report. Next Avenue. Retrieved from

https://www.nextavenue.org/long-term-care-bankrupting-us/

Gabriel, B. (2018, May 7). By 2040, one in five Americans will be over age 65: New federal

report documents a rapidly aging population with longer life expectancies. AARP.

Retrieved from https://www.aarp.org/politics-society/history/info-2018/older-

population-increase-new-report.html

Govtrack. (2019). S.1351: Americans giving care to elders (AGE) Act of 2019. Retrieved from

https://www.govtrack.us/congress/bills/116/s1351/text/is

Govtrack. (2019). Susan Collins: Senator for Maine. Retrieved from

https://www.govtrack.us/congress/members/susan_collins/300025

Huddleston, C. (2017, December 29). Why it’s harder to save for retirement today than 50 years

ago. Go Banking Rates. Retrieved from

https://www.gobankingrates.com/retirement/planning/why-its-harder-save-retirement-

today/
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Long-Term Care: Not If, but When. (2017). Journal of Financial Planning, 30(4), 13. Retrieved

from

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360392&site=ehost-live

Lumby, J., Browning, C., & Finke, M. S. (2017). The Impact of Product Knowledge and Quality

of Care on Long-term Care Insurance Demand: Evidence from the HRS. Journal of

Personal Finance, 16(2), 48–61. Retrieved from

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Mason, d., Gardner, D., Outlaw, F., & O’Grady, E. (2016). Policy & Politics in Nursing and

Health Care. St. Louis, Missouri: Elsevier.

Mechanic, D. (1985). Challenges in long-term policy. Health Affairs 6(2). Retrieved from

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.6.2.22

Siegel, S., & Rimsky, N. T. (2015). Where Do We Go From Here? Long-Term Care in the Age

of the Baby Boomers. NAELA Journal, 11(1), 49–60. Retrieved from

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310006&site=ehost-live