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We need a common vision for aging in Minnesota

Among the thousands of pages of recently enacted statutes are laws that direct the state to research a myriad of health reform ideas in pursuit of both cost-savings and better value for consumers. At the heart of many of these redesign efforts is a debate about how best to meet the demands of our aging population.

As we dive into this important work, we must start with a common vision of where we’re headed – what it should mean to age in Minnesota. The point must be made that not all seniors are vulnerable. But it is an undeniable fact that at least one in five of us will need long-term care during our lifetime.

As a boomer myself, I’ve spent the past 40 years in older adult services, first as a nursing assistant, then as a social worker and now as the leader of an organization that represents over 1,000 long-term care providers. Just weeks away from my 60th birthday, I am more keenly aware than ever of what I wish for my own aging experience – a vision for my aging.

I suspect my vision is not that different from yours:
 
I want to live in the place I call home for as long as possible. I want to be in control of the decision about where I live, what kinds of support or services I use and when to make changes in my lifestyle. And of course, as a boomer, I want choices.

The reality is that this part of my vision is more within my reach if I have my own money to pay for it. That’s where my personal self-interest and the interests of the state are perfectly aligned. Public policy should give me incentives and tools to save for and pay what I can toward my own long-term care needs.

Private long-term care insurance is a part of the answer, but by the time most people need it, coverage is hard to get or simply unaffordable. There are options worth pursuing that can help us overcome these barriers, such as life-insurance conversions that would allow individuals to convert the value of an existing life-insurance policy to pay for their long-term care needs, rather than a cash benefit being paid out upon their death. There also is growing interest around the value and flexibility of “money follows the person” programs that allow individuals greater control and customization of the care they receive.

Clearly, the best time to buy long-term care insurance will always be when we are young. That’s why there is merit in the idea of potentially expanding the current opt-in life-insurance benefit offered to state employees. This is a voluntary program with premiums paid by the individual — it is affordable and easy, which means that more young employees take advantage of it at no additional cost to the state.

Even with any or all of these ideas in place, not everyone will be able to save enough to pay for their own long-term care. Catastrophic events do occur, which is why a combination of better personal savings and a solid safety net is needed to make sure all Minnesotans get the care they need.

Housing, service and health-care providers should be accountable to me as a consumer and work collaboratively to promote my health and well-being. I am looking for quality, integrity and a bond of trust with providers. Third-party regulation has historically been our accountability tool, but increasingly, accountability will and should be led by providers and consumers working together, built around the total service experience and the outcomes we achieve. For example, some long-term care providers are now using iPad technology to do real-time customer satisfaction surveys and discharge interviews, instantly utilizing that information in data-driven quality improvement programs.

In the hospital and clinic world, after-the-fact regulatory enforcement mechanisms have been supplemented by proactive patient safety initiatives that allow the provider to report an error without fear of recrimination. Providers then identify what the “root cause” of the error was and design a corrective approach that can be shared across the provider community to help prevent similar occurrences in the future. No such opportunities exist today in the world of long-term care, but the model is there for us to pursue.

And just as we expect providers to be accountable to us for quality, we must be willing to make the public investment in them to create environments that support dignified, independent aging.

None of us wants to end up in a hospital for medical attention, but if we find ourselves in that position, we want to know the very best quality care and caregivers are there for us. The same holds true of long-term care. Adequately funded older adult service providers can deliver higher quality care in more efficient, innovative ways and, most important, attract workers with that unique combination of skill and passion for care giving.

Care giving should be an honored and sought-after profession attracting the best and most caring. The core of our older adult services workforce is middle-aged women working without health insurance or retirement benefits. These workers receive lower wages and benefits than those who do similar work in virtually all other health-care sectors. And yet, these are the people who provide the most intimate daily care of our loved ones when we cannot.

My own sister has made a career of care giving as a nursing assistant for the past 26 years. She is 62 years old and beginning to feel the effects of years of lifting and bending. Early retirement is not an option, nor is lighter duty — as budgets have been cut, she is responsible for the daily care of more residents, not fewer, and those residents have more challenging needs. Due to state reimbursement policy, she has not had a wage increase in three years. And as a result of this past legislative session, the organization where she works will get an increase in its daily payment rates from the state — an increase of one penny.

Today’s circumstances raise the question of how we will attract the next generation of dedicated professionals who embrace the hard work and deep personal rewards of care giving. Even with the promise of new technologies, our work revolves around people taking care of people. We must start with the basics of ensuring a living wage and health insurance for these workers and build from there with career-enhancing educational and training opportunities. For example, the state’s new Health Support Specialist apprenticeship program is a first-of-its-kind effort to transform the career opportunities available to workers in the long-term care field.
 
The future of aging and long-term care affects every single Minnesotan, regardless of age, culture, economic status or geography. It affects the vibrancy of our communities, our economic stability and our ability to keep our promises to the most vulnerable among us.

 A great deal of opportunity lies ahead as we reform the way we deliver care and services to our aging population. We don’t have to agree on every detail, but we will fail miserably if our reform and redesign efforts are not led with a common vision for what it means to age in Minnesota.

Gayle Kvenvold is president and CEO of Aging Services of Minnesota, the state’s largest trade association representing more than 1,000 long-term care organizations.

Comments (3)

  1. Submitted by Richard Schafer on 09/06/2011 - 10:55 am.

    “Private long-term care insurance is a part of the answer, but by the time most people need it, coverage is hard to get or simply unaffordable.”

    So, what’s a sensible solution? It’s pretty obvious, reduce public long-term care dependency and cost by targeting scarce government resources to those most in need while incentivizing everyone else to plan early and save, invest or insure for long-term care. Make sure there are no ways to escape personal responsibility for long-term care. Let home owners pay for in-home care with reverse mortgages. Let them pay for institutional care by sale of the home or through estate recovery. If heirs want to preserve their inheritances, let them find ways to pay for their parents long-term care. Such policies would take the financial burden off government and transfer it to individuals, families, and inheritors where it belongs and where it provides a strong incentive to prepare responsibly for long-term care.

    Plan early. Save. Invest. Insure.

  2. Submitted by Bernice Vetsch on 09/07/2011 - 11:01 am.

    Mr. Schafer: Ten or more years ago, long term care insurance itself was unaffordable ($250-plus per month) for any but high-earning persons and would be higher now. Many people own no property and will have no “estates” from which long-term care costs can be recovered.

    And, of course, in today’s world, millions of Americans who have lost both their jobs, their homes and their health insurance will never find work again.

    The feds (Medicaid), state and counties must find ways to afford care for those who cannot cover it themselves.

  3. Submitted by Richard Schafer on 09/08/2011 - 01:25 am.

    The feds (Medicaid), state and counties must find ways to afford care for those who cannot cover it themselves.

    Exactly! Protect Medicaid for those genuinely in need. Everyone else, who is healthy enough and wealthy enough must plan early, save, invest, insure.

    The best strategy to prevent or ameliorate the impending collapse of publicly financed long-term care is to . . .
    • relieve the LTC financing pressure on Medicaid by targeting the program to the most needy, and
    • use some of the savings to incentivize LTC planning, home equity conversion and private long-term care insurance.

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