In a much-discussed early-morning vote on July 28, the U.S. Senate voted decisively to move in a different direction on health care, sending a clear signal that future reform efforts will likely have to be bipartisan. Affirmation came on August 1, when Sens. Lamar Alexander of Tennessee and Patty Murray of Washington, the Senate Health Committee’s top ranking Republican and Democrat, announced bipartisan hearings will begin this fall on possible policy solutions for American consumers and insurers participating in state exchanges.
Yet, beyond the fights over “repeal and replace,” a larger issue is looming: Our health care system is not prepared to care for the age wave—which will come with a surge in need for ongoing, daily assistance. Congressional representatives from both sides of the aisle must work together to plan for burgeoning numbers of elders and individuals with disabilities, recognizing that there are diminishing numbers of family caregivers, and that the health services and delivery system as currently configured is poorly designed to meet long-term care needs.
Combining Forces for Better Policy
Fortunately there are stirrings of interest and activity: Rep. Ileana Ros-Lehitnen of Florida, the most senior Republican woman in the House of Representatives, joined Rep. Michelle Lujan-Grisham, a Democrat who served as Aging Secretary in New Mexico before her election to Congress, to introduce the Care Corps Demonstration Act. HR 3494 is a thoughtful measure that is designed to galvanize communities by helping them train and deploy volunteers of all ages, whose mission would be to help aging neighbors, friends, colleagues, and family members thrive in their own homes. Rep. Ros-Lehitnen’s predecessor from the 27th District of Florida was one of Congress’ best-known champions of older adults, Rep. Claude Pepper. Rep. Ros-Lehitnen announced on April 30 that she would not be running for re-election, while Rep. Lujan-Grisham has said she will run for Governor of New Mexico in 2018. Before Reps. Ros-Lehitnen and Lujan-Grisham leave Congress, they are trying to recruit supporters from across the aisle and around the country for the Act, so that it can either find its way into a “must pass” bill, or attract widespread acceptance as a standalone measure.
Here’s what the Care Corps Demonstration Act would do:
- Invite groups to apply for Care Corps grants and administer the program locally;
- Train volunteers to support the achievement and maintenance of the highest level of independent living (but not provide professional medical services, administrative support services, or institutional care) and deploy them to communities in need; and
- Award Corps members living allowances and benefits, including health insurance coverage, during their volunteer period, and offer tuition assistance or loan repayment after completion of their assignment.
“It’s clear that seniors want to remain in their homes and they want control over their own health care,” Rep. Lujan-Grisham noted on introduction. “Most of all, they want to remain as independent as they can, for as long as they can. The same is true for individuals with disabilities. Care Corps will allow them to keep that independence. Unfortunately,” she added, “we’re facing high costs, along with a shortage of direct-care workers, which results in the lack of access to these important services, especially for middle class families. A national Care Corps will help build the workforce, while building intergenerational relationships that allow seniors and young people to learn from each other.”
Addressing the looming shortage of direct care workers is exactly what Rep. Bobby Scott of Virginia’s third congressional district is setting out to do. Next month, the Virginia lawmaker will introduce the Direct Creation, Advancement, and Retention of Employment (CARE) Opportunity Act (or Direct CARE Opportunity Act), which will propose to give the Department of Labor funds to establish advanced care training and mentoring programs and establish career ladders and better job opportunities, for direct care workers in up to 15 parts of the country. “Direct care workers are instrumental in supporting and assisting people across the country, particularly seniors and people with disabilities,” said Rep. Scott. “Moreover, if we invest in the direct care workforce, we invest in a rapidly growing and in-demand field. Growing the number of direct care workers is simply a win-win for investing in both the health of our communities and the jobs of tomorrow.”
PHI, a leading national organization representing and supporting direct care workers, is strongly backing Rep. Scott’s efforts: "Direct care workers are a critical part of delivering quality, person-centered long-term care, and we support this national effort to increase training, improve retention, and enhance the overall quality of jobs for this workforce," noted Daniel R. Wilson, director of federal affairs.
Additionally, on July 27 Rep. Matt Cartwright of Pennsylvania’s 17th congressional district introduced the Improving Care for Vulnerable Older Citizens through Workforce Advancement Act. “This bill would improve both the quality of jobs for direct care workers nationwide, as well as the care they deliver, by helping to create expanded roles with sufficient training and compensation, and by helping them support people with increased complex conditions, such as Alzheimer’s and related dementias, congestive heart failure, diabetes, and other chronic conditions,”said PHI President Jodi M. Sturgeon.
Creating a System that Can Meet the Needs of Aging Americans
Together, these bills represent crucially needed investments in thinking through how to train more men and women who can serve on the frontlines of a multi-generational society in an era of mass longevity. With a majority of women now in the workforce and smaller and more scattered families quickly becoming the norm, the availability of traditional family caregivers—middle-aged women—is shrinking rapidly. This is giving rise to an urgent need to create a more flexible, community-focused workforce that is prepared to provide targeted supports in home settings on an as-needed basis to an increasing proportion of elders and individuals with disabilities.
Beyond the workforce, there is a need for more policy analysis and research to adapt and revamp existing social insurance programs that are still organized around delivering episodic medical services, and with financing protocols that are designed to pay providers and organizations without regard to the population’s need for ongoing services across a given geographic region or community. Making this shift—from provider-centric financing models to population health models—will also require tweaking payment rules to reward comprehensive, longitudinal services that include long-term care; adjusting performance metrics to emphasize population health and incorporate key social determinants of health factors; better information technology to foster communication across multiple providers and with individuals living at home and their family caregivers; and development of ways to accurately measure need, quality, and supply of services at a community level, with the help of local leaders and experts.
There are signs that lawmakers may rise to the challenge of helping to forge solutions to these issues. In the House, an ad hoc “problem solvers caucus” has surfaced with a set of initial ideas for fixing state exchanges, and the group of roughly 40 lawmakers may continue to hold discussions about other topics. There is solid bipartisan, bicameral work being done in the Assisting Caregivers Today (ACT) caucus on long-term care issues. Parallel caucuses focusing on Alzheimer’s and other types of cognitive impairment have already made excellent contributions to development of policy on “cure” and “care.” These and other budding efforts have the capability, if further developed, to begin contributing ideas necessary to address larger-scale systems challenges in ways that can inspire and complement the work of researchers, advocates, families, providers and stakeholders.
Between now and 2030, the U.S. will change profoundly as mass longevity becomes a central dynamic. To prepare, now is the time to invest and build for long-term care, not disinvest; to map existing assets and use current programs as platforms for improving and making more efficient; and to generally acknowledge gaps and focus work on addressing common goals in a long-lived society.
In summary, evidence-based, high-value health care reform is greatly aided by congressional bipartisanship, but more is needed. To create a value-based system requires the combined efforts of many. Now that bipartisanship is breaking out, let’s get to it!