Health Care Reform: A Step in the Right Direction towards Home and Community Based Supports for Long Term Care

The passage of the Patient Protection and Affordable Care Act (PPACA) is one small step for long term care reform in this country, and a giant leap forward for health care overall.  While long term care took a surprising, or maybe not so surprising, back seat to the health care reform debates that raged in Washington, at least a few new policies made it into the final version that President Obama signed into law on March 23, 2010.

Overall, I think a number of things will change for the better as a result of this legislation.  First, with so many more people insured under the new law – up to 95% of US citizens – the burden of coverage will impact fewer people prior to needing long term care.  Basic health coverage for all, in essence, will keep some who formerly would not have had access to basic health care healthier longer.

Second, the new law makes some important improvements to Medicaid and Medicare, the two government programs that currently support some portions of long term care in this county.  Medicare includes limited prescription benefits and covers the cost of rehabilitation for persons 65 or older during the first 90 days of a hospitalization.  Medicaid pays for nursing home care and limited home- and community-based care for persons who qualify as living with a disability or living at or below the federal poverty level.  Changes to Medicaid and Medicare under the new health law includes reducing fraud, abuse and inefficiencies to Medicare without cutting benefits; closing a gap in Medicare prescription drug benefits; and improving coordination of care between the two programs.

Right now the bulk of long term care in this country is provided by family members and friends.  According to Howard Gleckman, more than 80 percent of long-term care is informally provided by families and friends at an estimated value of $350 billion per year (Gleckman 2009:19).  The third area covered under the new health law that could have a substantial impact on how long term care happens in this country offers assistance to the efforts of many families who are attempting to keep their loved ones out of nursing homes.  The Community Living Assistance Services and Supports (CLASS) plan in the new law is a legacy of Senator Edward Kennedy.

The CLASS plan establishes a new public long-term care insurance program geared towards funding home- and community-based supports.  Once someone has paid into the program for a minimum of five years, they will be eligible to receive an average of $50-75 per day to help them pay for home or community based care.  This may seem like a small amount, but sometimes it doesn’t take much to keep someone safely in their own home.

More importantly, however, this reverses a long-standing precedent that has privileged nursing home care over home- and community-based care for persons who are elderly.  If this reversal takes hold, it could eventually lead to substantial changes in how long term care is done in this country.  Institutional care may provide a high level of medical care, but it often significantly impedes a person’s access to social networks, self-determination, and self-sufficiency.  Literally, too many of our parents are dying social deaths in these institutions designed to care for their medical needs over their social, spiritual and personal needs.  If this law allows for some to stay at home or in community-based settings it could be the start of a new way of caring for our parents as they age.

I am certain that implementation of the new health law will have good days and bad days, but given what I have seen in this country and elsewhere, I see it as a step in the right direction.  Frances Norwood, PhD, author of The Maintenance of Life: Preventing Social Death through Euthanasia Talk and End-of-Life Care – Lessons from The Netherlands,” (2009)


Chernoff, Bruce.  Healthcare Reform:  What’s In It for Our Seniors?  LA, March 30, 2010; Accessed at

Chernoff, Bruce. A Summary of the Patient Protection and Affordable Care Act (P.L. 111-148) and Modifications by the Health Care and Education Reconciliation Act of 2010 (H.R. 4872), The SCAN Foundation Policy Brief (2), March 2010.

Girshman, Peggy.  Health Bill Provision On Long-Term Care Will Affect Baby Boomers. Kaiser Health News, April 13, 2010.  Accessed at

Gleckman, Howard.  Caring for Our Parents:  Inspiring Stories of Families Seeking New Solutions to America’s Most Urgent Health Crisis.  NY: St. Martin’s Press, 2009.

Health Care and Education Reconciliation Act (P.L. 111-152)

Justice, Diane.  Long Term Services and Supports and Chronic Care Coordination:  Policy Advances Enacted by the Patient Protection and Affordable Care Act.  State Health Policy Briefing, National Academy for State Health Policy, April 2010.

Patient Protection and Affordable Care Act (P.L. 111-148)