National Invitational Conference on Long-Term Care Data Bases: Conference Proceedings. Steven A. Grossman, Department of Health and Human Services


First, on behalf of Dr. Robert Windom, the Assistant Secretary for Health, and myself, we would like to welcome you to this Conference. Long term care, and you will hear this in different ways, is, in my opinion, the big intellectual planning challenge for health care in America for the next 40 years.

The demographics are there, and hopefully, for a change, unlike the school boom of the 1960's and other pieces of demographics, we have learned our lesson. We know that demographics without study and demographics without action is courting disaster.

You will learn a lot not only about the basic demographics, but what we know about things that can be projected into the future.

There is not an obvious solution or even sufficient insight to know exactly how to make that future work for all of us who will eventually have long term care needs. That is the job that did not start here, but to which we hope this Conference will be a big boost, and which will carry each of you forward into providing additional insight through your research, through your activities in insurance companies and in health care providers, to make sure that the long term care system meets our nation's needs.

Our system, as all of your know, is expensive. It is heavily oriented to institutional care. Most of all, it is confusing. It is confusing in a policy way. We need to change the way the consumer approaches the long term care system. We do not have all the information we need, not by a long shot.

It is also important to emphasize that the long term care field right now Is a public/private partnership. About 50 percent of long term care funding in this country, at least of the nursing home portion, is paid through public dollars. It is primarily Medicaid, but it is also Medicare; it is also Older Americans Act programs, Veterans Administration (VA), Social Services Block Grants, and a variety of other initiatives.

The federal government is a partner; the state governments are partners; local governments are partners through the programs.

The governmental dollar, as I say, approaches 50 percent. The problem that we faced when we looked at catastrophic costs as part of the Secretary's initiative was therefore the private dollar.

We all acknowledge that those public dollars may be able to be spent better, and that is a worthy subject for investigation, research and analysis.

Our study looked at the private dollar. It is half of the dollars flowing into the field; it is not, however, keyed the way any other social good is paid for in this country. Insurance is not the primary form of private long term care dollar. Out-of-pocket expenditure is. That is not how people protect against fire losses; that is not how they protect against Ill health. The report that the Secretary asked my group to do, and which would not have been possible to do without the leadership of Arnold Tompkins, Mary Harahan and their staff, was to look at those private dollars and try and say, is there a better way? Can we help people plan for their long term care needs so that whatever needs they have for public dollars will be secondary and only if their own resources fail them?

In the report we said that we need more savings mechanisms, more insurance mechanisms, and most of all, consumer education.

Those are all fair game for research. We need the answers in those areas. We need to look at family structure. There are already built into those demographics some ways in which that family structure will change. The largest proportion of all long term care in this country is provided free by families and friends. I will risk speaking on behalf of the Department, even though this is not in any way clear, and say that there will be no "solution" to the long term care needs in this country that does not support that system, because that is the system that is the most humane, that every study says that the elderly themselves want.

Whatever structures we need to deal with those who cannot stay at home, we need to make sure that we do not create Incentives that are counter to encouraging people who want to be at home to make use of that opportunity.

I welcome you all. There is a big challenge before you. The challenge is in the next day and a half, but it is also in the next 50 years. There is lots of opportunity for contribution, and I ask each of you to do what you can to take that opportunity.

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