Over 12 million Americans today rely on long-term services and supports in their home or community or in an institution. That number is expected to swell as the baby boomer generation ages and the number of available caregivers dwindles. The Washington Post spoke with Bruce Chernof, president and CEO of The SCAN Foundation and chair of the bipartisan federal Commission on Long-Term Care, which today released a report with recommendations for a targeted long-term care approach as America ages. Some had hoped the commission would develop a new public or private insurance program to help finance long-term care, but Chernof said that was not part of its mandate. The recommendations include new models of public payment, better communication with family members, better monitoring and training of caregivers, and creating a Medicare benefit for long-term care.
WP: Can you give us a snapshot of the nation’s upcoming long-term care needs?
BC: As a country we’re living much longer than we ever have. Seventy percent of people over 65 will need some form of long-term services and support, and on average they’ll need it for three years. The American public doesn’t acknowledge that; people fundamentally don’t understand who will be there for them when they hit that point in time. We need to get the message out that we’re all going to need a little help. Many assume Medicare will be there for them, but it isn’t going to be there for long-term services and supports until they spend all their savings.
WP: How does long-term care fit in with the broader health care debate?
BC: If you want to really reform the medical system, you have to address this issue. The failure to address it impacts state and federal budgets. When all else fails, the light that’s on all night is the emergency room door.
WP: The commission voted 9 to 6 in favor of the recommendations. What were the points of contention? Did they divide along party lines?
BC: Among the nine who voted for the recommendations, four were Democrats and five were Republicans, and among the 6 dissenters, 5 were Democrats and one was a Republican. For the most part, the dissenters would have hoped to see the report go farther. I think it’s fair to say the Democratic appointee commissioners would prefer to build out our social insurance approach and Republicans prefer financing through private options.
WP: We’ve come this far without overhauling long-term care; what if we just carry on the way we’ve been going?
BC: People have been saying, “Oh yeah, yeah, they’ve been talking about that for 20 years, they’re saying the sky is falling.” But I actually do think that now is the time to address it. For the boomers, we have kind of a narrow window — in about five years the majority of boomers will be either past retirement or too close to retirement to really be able to pick up and use any new tools or options to plan successfully.
WP: What happens next?
BC: Technically, we’re done. We were given a charge to solve a problem in 100 days that Congress has been chewing on for a couple of decades. The commission felt very strongly that our task was the beginning, not the end. Congress needs to look at really creating some kind of advisory committee that can continue our work on a more long-term basis.
WP: How realistic is it to expect that the commission’s recommendations will lead to concrete actions by Congress?
BC: I am optimistic. We’re getting to a point where public awareness is starting to increase, and where dignified choice is very important to people and their families. This country’s got a lot on its plate right now, but I am confident that with the push of the American public, we can get there.