I recall seeing one of my mentors, medical sociologist and long-term advocate for nursing home reform, Charlene Harrington speak in Washington, DC. She said she had been advocating for nursing home reform for more than 20 years and that in those 20 years she had seen little positive change. The Affordable Care Act (ACA 2010) may well be the turning point that Dr. Harrington was looking for. From what I have learned of the ACA, this piece of legislation offers a first step towards real transformation of how we care for and support our parents and loved ones as they age. What the ACA does is facilitate the use of state and federal funding streams for home and community-based services and basic health care for all, both of which should have an important impact on how we age.
Here is what the Affordable Care Act has to offer: First, there is a much greater emphasis and facilitation for states to support home care and community-based living for people as they age. The Community Living Assistance Services and Supports (CLASS) Program 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. Section 2401, the Community First Choice Option, allows states more freedom to provide attendant care and increases the Federal coverage for these services. Section 2402 offers a number of ways to reduce barriers and facilitate access to a wide array of home- and community-based services through the existing Medicaid HCBS waiver programs. Section 2403 extends until 2016 what has been a successful demonstration project started under President Bush, Money Follows The Person. These grants allows states to develop projects that allow people to choose where they want to live, giving people with care needs the option to live at home or in the community as opposed to in a nursing home. Section 10202, the Balancing Incentives Program, also helps states have better flexibility to spend their money on non-institutional services.
Second, there appears to be some steps for reforming institutional care. Section 2701 includes the development of adult health quality measures and Section 2703, Health Homes for Individuals with Chronic Conditions, appears to be a measure to reformulate how institutional care is delivered for persons with a focus on “person-centered” care.
Successful long term care is so much more than the latest medical breakthroughs and treatments. It is about providing families with the supports they need to care for their loved ones and when family are not able to do that it is about stepping in to serve that function in the most humane and life-affirming way possible. Universal access to health and social supports is critical for transforming long term care in the U.S.. American families are carrying too much of the burden and while gaps are sometimes filled locally by community- and faith-based organizations and in part by national programs of Medicare and Medicaid, this is not enough.
Fixing this system does not necessarily mean spending more money on increasingly costly medical technologies, pharmaceuticals, or the latest medical advancements. It means spending wisely on home care, nursing and personal care, respite for families, and coordination of care, such as case management. It means doing further research on innovative and cost-effective solutions at the end of life, shifting the focus of federal dollars from nursing home to home- and community-based care where relationships can continue to keep people connected to life. It means looking into new ways to deliver nursing home and hospital care for those who do need that level of care. It means tapping into local resources (community- and faith-based initiatives) that have come to find cost effective and humane, care-based programs for persons who are elderly, disabled or dying. I believe the Affordable Care Act (2010) is that step in the right direction that we have all been waiting for.