Long Term Care and Supportive Services for the ELderly

PREAMBLE: As our population ages, the need for a comprehensive system of affordable, quality long-term care services (herein after “long term care”) and for innovative, cost-effective ways to provide these services grows more acute. Jewish values teach us that older people deserve deference and respect. According to Rabbi Issi ben Yehuda, we are obligated to honor those who are old, regardless of their income or level of education (Kiddushin 32b-33b). Respecting that obligation, the organized Jewish community historically has supported a wide range of services for the elderly and has joined in the search for effective ways to meet the health and welfare needs of the nation’s growing population of older Americans. The Jewish Council for Public Affairs (JCPA) reaffirms its commitment to these values and to the imperative of working for the development and implementation of creative national and statewide policies for providing quality, affordable long-term care services.

BACKGROUND: Today, older Americans comprise 13 percent of the population. That number will rise to 20 percent over the next thirty years, as the number of Americans who need supportive services most, those 85 and older, more than doubles. Within the Jewish community, individuals over 65 comprise nearly 20 percent of the population, higher than in the community-at-large. Here again, the fastest growing segment is over 85. As this population strives to remain independent, the need for support services grows. Long term care involves a continuum of services, including health, housing, transportation, and social services provided in a variety of settings, from in-home and community-based care to care in institutional settings. The goal is to address the specific needs of seniors and of their caregivers in a way that is affordable, available to all, regardless of income, and that provides adequate opportunity for consumer choice. 

PRINCIPLES FOR OLDER ADULT SERVICES: The JCPA’s position on specific policy proposals for provision and funding of long term care will be based on the principles described below.

Affordability: Long term care can be a costly and often severe financial burden. Medicare does not provide support for most home and community-based care, long stays in nursing homes, or for prescription drugs, nor do most private health insurance plans. Although prescription drugs properly used can help Americans avoid costly hospital stays, control and treat disabling health conditions, and help prevent further decline, millions of older Americans lack coverage or are in danger of losing it. While private long-term care insurance is available, many cannot afford the high premiums or cannot qualify for coverage due to pre-existing medical conditions. As a result, seniors often face financial hardships and cannot pay for the essential housing, health care, and other necessary services that would enable them to maintain their independence. 

Currently, our national health care insurance programs are not designed to adequately meet the long-term care needs of this population. To improve conditions, both Medicaid and Medicaid eligibility standards and Medicare services should be expanded and both programs should be strengthened financially, to ensure viability as the aging population grows over the next several years. Further, since public programs alone cannot satisfy fully the demand for long term care services, state governments should be urged to monitor and ensure that insurance carriers provide affordable, quality, private long term care insurance policies. Too few Americans are aware of the availability and importance of these policies for their retirement planning. Federal and state governments can help by creating incentives to encourage younger adults to invest early in private long-term care insurance. 

Consumer Choice: Older Americans need more and better choices about where they live and the kinds of services that best meet their needs, and assured access to religiously and culturally appropriate services including housing, home- and community-based services, home care and hospice programs, long-term care facilities, and acute care. Yet, for Medicare and Medicaid recipients has led to a loss of consumer choice. As a result of plan restrictions, older Americans at times cannot continue receiving care from a long-known family physician and may not be able to select a long term care facility that is near their family or is religiously appropriate. 

In-Home and Community-Based Care: To preserve independence, dignity, and family ties, older Americans need greater options for receiving services in their own homes and communities, where many prefer to stay and where in fact costs are often lower than the cost of providing nursing home care. One way that is happening is through the creation of support systems in what have become known as Naturally Occurring Retirement Communities (NORCs). These can be apartment buildings, suburban neighborhoods, or planned communities where residents have “aged in place” over a period of several decades. Bringing services to them where they live, including medical care, social services, home renovation, and caregiver support, can be part of a cost-effective continuum that helps to ensure a high standard of care. The Older Americans Act (OAA) is the primary vehicle for coordinating and providing community-based services, including a wide range of services to help frail older people remain independent and in their homes as long as possible. Recent reauthorization of this act reverses an extended freeze in funding for these critical services. 

There is a related need to increase the stock of housing available to seniors with low incomes, through new and refurbished units. Due to past budgets cuts, and a resulting decline in available housing for the elderly and non-elderly alike, waiting lists for housing with assisted services and Section 202 housing have become unacceptably long and can exceed ten years in densely populated urban areas. 

Caregiver Support: The role of caregivers is essential to enabling the frail elderly to remain in their homes for as long as possible and to providing quality care in long term care facilities. However, the availability of professional caregivers is limited and the need for them is growing, in both community and institutional settings. The demanding work, low pay, and lack of health or retirement benefits have created serious quality and retention problems. There is a growing national awareness as well, of the significant role played and support needed by informal caregivers who provide uncompensated services to family members and others needing long term care. In response, Congress recently created the National Family Caregiver Support Program, which recognizes the contributions made by family members and friends. The program provides information on available resources, education and training, counseling and mental health care for caregivers.

ACTION PRIORITIES

In recognition of current conditions and concerns, the JCPA supports and will work for: 

• Educational efforts to increase awareness by Congress and the Administration of the limitations in current national health care insurance programs, which are not designed to adequately provide long term care services.

• Redesign of Medicaid and Medicare programs, through appropriate legislation, to ensure a long term care system that provides greater choice, access to information about available choices, and increased access to and availability of in-home and community care, along with strong consumer protections and public accountability for public dollars; 

• Efforts by state and federal governments to do a better job of ensuring the promotion and availability of quality, affordable private insurance programs for young and older Americans alike;

• Initiatives to ensure the ability of older adults to access religiously and culturally appropriate housing, home care, hospice, acute care and long-term care facilities; 

• Federal and state government support for innovative social and health service programs for the elderly, including services provided at NORCs and other creative service delivery programs, including those that integrate social services and housing for the elderly population; 

• Increased funding of affordable housing for low and moderate-income older adults, as well as related support services for residents, such as transportation and social services; 

• New options for covering and containing some portion of the cost of prescription drugs; 

• Building upon the National Family Caregiver Support program, which recognizes the importance of informal caregivers, increased support for professional caregivers through innovative strategies for recruitment and training, and improved reimbursement rates;

• Increased funding for elder abuse investigation and services, education and outreach;

• Full and adequate funding for services provided under the recently reauthorized Older Americans Act, the primary vehicle for organizing, coordinating and providing community-based services.

• Federal and state initiatives, including training and competitive salaries, to address the underlying causes of elder care staffing shortages, particularly with regard to nursing shortages.