U.S. Department of Health and Human ServicesU.S. Department of Health and Human Services
This report--which summarizes a national conference held at the Ritz-Carlton Hotel, Washington, D.C. on May 21-22, 1987--was prepared by the Office of Social Services Policy with the U.S. Department of Health and Human Services. For additional information, you may visit the DALTCP home page at http://aspe.hhs.gov/daltcp/home.htm or contact the Office of Disability, Aging and Long-Term Care Policy, Room 424E, H.H Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The DALTCP Project Officer was Robert Clark.
It is certainly a pleasure to welcome all of you. It is amazing that we could get this kind of turnout for a Conference on Long Term Care Data Bases. It speaks to the importance of this issue.
This Conference is jointly sponsored by my office, the Office of the Assistant Secretary for Planning and Evaluation, or ASPE, as we usually call it, and the Office of the Assistant Secretary for Health, or OASH. We work very closely with Bob Windom, Steve Grossman, and their staffs.
I sometimes tell people that ASPE is the Secretary's Policy Shop. We are engaged in a kind of a long range planning and so on, but the real reason we exist is to provide a job for Mary Harahan. I want to first of all thank Mary in particular, and the people in the Division of Disability, Aging, and Long Term Care, for their hard work in setting up this Conference.
There are three reasons for holding this Conference. First, it is the formal follow-up to Secretary Bowen's Catastrophic Illness Study. In his report to the President, the Secretary underscored the importance of "improving the knowledge and understanding of Americans regarding the risk of needing long term care, and the options for financing it."
The analysis of large valid and reliable long term care data bases can help significantly to expand our knowledge and understanding about who needs long term care, how much it costs to provide care, and the impact of various financing proposals on public and out-of-pocket costs.
In my judgment, a thorough exploration of how best to maximize private insurance and other private financing options is one of the most critical research priorities of this Department.
Second, over the past several years, the Department of Health and Human Services (DHHS) has undertaken a number of major data collection efforts pertaining to long term care.
As a result there has been considerable improvement in the breadth and quality of data available to examine the use and cost of long term care services. In this Conference, we are deliberately focusing on data bases that are or soon will be publicly available.
Third, long term care continues to attract the attention of Congress, advocacy groups, insurance carriers, and others within our political and economic system. It will remain an area of national policy and significance in the foreseeable future.
The appropriateness of public policy responses and private sector initiatives depend largely on the development of a body of high quality research derived from the best available data.
I believe that our Department has a major responsibility, not only to collect data relative to public policy, but to assure that public use files are made available as quickly as possible for the use of researchers, policy analysts and private sector organizations.
I do not say that lightly. That is something that the government has not always had a good record in. This Conference is intended to acquaint you with the current supply of long term care data bases, and frankly to stimulate the demand for that data.
The audience for this Conference includes researchers, private sector representatives, with emphasis on the insurance industry, federal agency and Congressional staffs, nonprofit association members, and others.
We anticipate that the cross-section of interests represented in this audience will contribute some valuable synergy to the proceedings.
We hope that the Conference achieves several objectives. One objective is to share technical information on the construction, documentation, and availability of large, long term care data bases.
It is important that not only researchers, but policy analysts and other users become familiar with the strengths and the limitations of these data bases and the kinds of issues they are best suited for.
Another objective is to provide a forum for acquainting ourselves with ongoing and completed analytical work that makes use of these data bases.
Many of you in this audience may be able to contribute information regarding your analytical needs and plans during the Conference sessions. Most importantly we want to examine the potential of these data bases for assisting employers, insurance carriers, continuing care retirement communities, nursing home operators, federal and state agencies, and nonprofit groups in projecting long term care service needs and costs.
As occurs in many conferences, the chief benefit may simply be the opportunity provided for a group of people concerned with the long term care needs of the nation's elderly and disabled population to meet and exchange ideas informally as well as formally.
If that occurs to a significant degree, we can count this Conference a success. Again, I wish to welcome you. I hope that your participation in this Conference on long term care data bases proves to be both rewarding and productive.
I would like to add my welcome to all of you as we begin this Conference.
My office, which is a part of ASPE, has had a longstanding interest in long term care issues. Much of our work is carried out in conjunction with other components of DHHS.
For example, the National Long Term Care Channeling Demonstration, which ended last year, was jointly funded and managed by our office, the Health Care Financing Administration, and the Administration on Aging.
We also provided considerable support to the Secretary's Catastrophic Illness Study, particularly the Technical Work Group on Private Financing of Long Term Care, chaired by Steve Grossman, our next speaker.
Several things have become clear as we grapple with the issues surrounding long term care. First, from a policy perspective, long term care is a hot topic. While acute care attracts the bulk of attention on Capitol Hill these days, long term care will inevitably become part of any resulting discussions.
Whether we are talking about the early discharges under the Medicare Prospective Payment System (PPS), the likelihood of an added Medicare Part B premium to offset catastrophic acute care expenses, or the expansion of home health care benefits, we are inevitably faced with the effects on the long term care system.
Above all, it is clear that the public sector alone cannot adequately address these issues. Private sector initiatives, like long term care insurance, and new financing mechanisms, like individual medical accounts, and home equity conversions are much needed.
Second, in spite of some exemplary research done to date, there is a great deal yet to be learned about the long term care system, including its beneficiaries, its services, and its payors.
We need ongoing research with respect to at least the following areas: the characteristics of persons with long term care needs, especially the disabled elderly; the changing patterns in the supply and use of long term care services; the particular characteristics of different types of nursing home residents, for example, short stayers, long stayers, and the terminally ill.
The use of home and community-based services; current and projected patterns in informal care long term care costs; and ways of addressing catastrophic long term care costs.
Third, in recent years, our capacity to examine the long term care system has grown significantly with the public availability of national long term care data bases, plus a number of demonstration programs and state and local surveys.
As Dr. Helms stated, we consider it critical to create and make available public use files from data collected under the sponsorship of the Department. This Conference is an outgrowth of all these developments.
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.