SOURCES: (1) United States Department of Commerce, Bureau of the Census. (2) Lewin-VHI, Inc. Long Term Care: Background Facts on Use and Financing June 1993; 4. (3) Vladeck. BC. "Long-Term Care for the Elderly: The Future of Nursing Homes." Western Joumal of Medicine February 1989; 150: 215-220. (4) United States General Accounting Office. "Medicaid: Determining the Cost-Effectiveness of Home and Community-Based Services." April 1987: 3. (5) United States General Accounting Office. "The Elderly Should Benefit From Expanded Home Health Care But Increasing Those Services Will Not Insure Cost Reductions." December 7, 1982: 43. (6) Weissert. William. "Seven Reasons Why It Is So Difficult To Make Community Based Long Term Care Effective." Health Services Research October 1985: 20 (4). (7) Hallfors, Diane Dion. Center for Vulnerable Populations. Institute for Health Policy, Brandeis University. "State Policy Issues in Long-Term Care for Frail Elders." March 30, 1993: 8. (8) Wiener. Joshua M. and Katherine M. Harris. "Myths and Realities: Why Most of What Everybody Knows About Long-Term Care is Wrong." The Brookings Review Fall 1990; 32. (9) Thornton, Craig and Shari Miller Dunstan and Peter Kemper. "The Evaluation of National Long Term Care Demonstration: 7. The Effect of Channeling on Health and Long Term Care Costs." Health Services Research April 1988; 23(1): 130. (10) Ibid..141. (11) "Medicaid: Determining the Costs....18. (12) "New York Officials Sound Alarm Over Bur geoning Home Care Bill." Reimbursement Bulletin February 16, 1993; 5 (17): 6. Mr. WYDEN. Mr. Goldberg, welcome. STATEMENT OF SHELDON L. GOLDBERG Mr. GOLDBERG. Mr. Chairman, thank you very much. It is my privilege to appear before this committee. It is a committee which has for a long time provided leadership and has championed the issues of access to the poor, and proper health care services and quality. My name is Sheldon Goldberg. I am the President of the American Association of Homes for the Aging. I think I come here today from a unique perspective. Yes, my members are all not for profit. There are 5,000 across this country. Today almost a million people receive services. We represent nursing homes, but equally we represent housing, community services, retirement communities, lowincome housing, a broad range of other types of services. I have to tell you something, I am excited at being here with the opportunity it presents. First of all, there is so much within the President's proposal which we support. Number one is the publicprivate partnership, the ability to infuse dollars into the program from those who have those resources. Most importantly, it is support of the home- and community-based services program. We see this especially for those who reside in the housing program, lowincome housing 202 as an opportunity to provide appropriate services to keep them independent as long as possible. We support the provisions which are involved pertaining to the expansion of long-term care as well as providing consumer protection by bringing a standard of, Federal standard to minimally regulate these to make sure it is appropriate for the consumers across this country. Demographically, we are at a crossroads in this country, and I hope that the Congress can seize the opportunity or seize the moment to move forward with long-term care reform. I recognize the fiscal realities we face, but it is my hope that the Congress will not jettison these issues and move on to health care reform without addressing this critical issue. Our fear is if they are not addressed now, it may be years in the future before we again talk about them. We are concerned, obviously, about the fiscal nature. We feel and strongly support the idea that the costs of the community base have to be on a sliding scale basis. To those who have the least amount of money to pay for them, they are the ones who should be receiving these services for free, and it needs to be directed in that way, and those who can afford to pay for the services, obviously they are the ones who should pay for them. We support this on the same premise that we feel there is probably going to be, to some degree, an adverse effect on nursing home payments. Certainly the freeze on Medicaid, Medicare, will have an impact. Because these are the sickest and the residents with the most promise of rehabilitation. We had hoped that the freeze could be lifted. We see more and more Medicaid residents coming into the nursing homes in the future simply by the demographic nature of what is going on. Our hope is we will not see States reallocate funds from the Medicaid program to provide proper reimbursement and to support other types of programs. We hope there is a commitment to maintaining the principles advocated for in OBRA 1987. Now, let me add a very major concern. There is a recent Federal court decision in New Jersey that defined in the 1987 OBRA, which this committee helped to write and champion, the highest practical level for the well-being of the resident. This court said, number one, that we will not support a superior standard of care. It said, number two, we will not support excellent care. And what concerns me the most is the court's ruling said it will not, quote, "support compassionate care." And I think what you have worked for for so long, and this is that we do not have a double-tiered system of care and that we have one system of care that is responsible to all, and that is why we are advocating that we do have safeguards to maintain a quality level and reimburse them for the care side of it. There is another provision that causes concern, and that is the idea that a new model exists called continuing care retirement communities, which is starting up, would possibly require that there is a minimum standard Federal regulations related to the Federal Government. CCRC's in this country are really very locally community-based organizations most of them sponsored by churches at the community level. I find it very difficult for them having the ability to relate to a Federal bureaucracy. We believe very strongly that they are really State issues. There are proper roles for the regulation and safety. We also advocate that there are an existence of accreditation programs, which are consumer driven, resident driven, that we think could adequately address those issues as well, and let me be very quick and come to a conclusion. We support very wholeheartedly the home- and community-based system. We support the concept that it be on a sliding scale so the economic resources that are there go to those who are the most poor and who need those resources. I will suggest very strongly that they have to be available for people in their residences. I use programs such as the 202 and other low-income housing programs. We obviously are very supportive of the provisions in OBRA 1987, at the highest level practical be maintained and not diminish in terms of those who reside in nursing homes. We see minimum Federal standards for long-term care insurance. They are needed; it is proper so we don't have a hodgepodge confusion in terms of how we approach and regulate insurance in this country. It needs one standard. We support CCRC's and obviously we oppose the freeze on Medicare. I appreciate your leadership and your opportunity for allowing me the opportunity to speak. Thank you very much. Mr. WYDEN. Thank you very much, Mr. Goldberg. That is very helpful. [The statement of Mr. Goldberg follows:] AAHA AMERICAN ASSOCIATION OF HOMES FOR THE AGING Mr. Chairman, I am pleased to be here today to testify on the critical issue of health care reform. I am pleased that this issue is a top priority on both the President's and Congress' domestic agendas and AAHA stands ready to lend our organization's assistance in helping draft a solution to insure adequate access to quality health and related services and financial protection for these services. AAHA is a national organization representing almost 4,500 non-profit providers of health care, housing, and community-based services for the elderly. Our members provide not only nursing facility care, but also independent senior housing, assisted living services, continuing care retirement care, home health care, adult day care, respite care, meals on wheels, and others services in a continuum of care to enable elderly individuals to remain independent as long as possible, as well as to care for them when they can no longer care for themselves. AAHA is committed to the reform of our nation's long-term care system as an integral part of health care reform. Only through such reform can we assure our nation's 32 million elderly citizens access to needed long-term care services and adequate funding for such care. Representing providers who collectively offer the full range of aging-related services, the Association recognizes the value of an array of housing and health-related services to ensure that the chronically-impaired elderly receive appropriate and cost-effective care in the most appropriate setting that accommodates their individual needs and circumstances. I want to applaud you, Mr. Chairman, for your leadership role in assuring high quality long-term care services for those who need them. Many of the dramatic improvements in nursing home quality in resident assessments, reduction of physical and chemical restraints, and residents rights the result of this Subcommittee and its staff. Today you are continuing your efforts to ensure that long-term care remains a vital component of the health care reform movement. - are The needs of our elderly citizens must not be overlooked. Roughly 32 million older Americans are without protection against the potentially catastrophic costs of long-term care services. The average cost of nursing home is approximately $36,000 annually. While lower than nursing home costs in some cases, home care costs for an individual receiving three visits per week would range between $10,000 and $15,000 per year, depending on the type of services and providers involved. Few elderly individuals can afford to pay for these services themselves, so they are forced to impoverish themselves to qualify for Medicaid. There must be a better way; that is one area in which we all agree. President Clinton has begun to improve long-term care coverage and financing with his Health Security Act. That plan would create a sweeping new home and community-based care benefit that would benefit all disabled individuals regardless of age, income, geography, nature of disability or Representing not-for-profit organizations dedicated to providing quality GENE E YODER, CHAIR SHELDON L. GOLDBERG, PRESIDENT residential setting. A wide range of services could be provided under the program, thus enabling many individuals to remain as independent as possible. The President's proposal would also include in the basic benefit package an "extended care" benefit to cover 100 days of nursing facility or rehabilitation facility services as an alternative to hospitalization after an acute illness or injury. The plan would be based on joint public and private efforts to cover long-term care services. There is much about Clinton's plan with which we agree: We agree that a new long-term care benefit must be based on a We agree with the need for expanded home and community-based services, provided in homes or residential settings, to promote independence. Such programs recognize that most frail elderly individuals would prefer to be served in their own homes, whether those are private residences or congregate residential settings. We agree with the need for state flexibility to create long-term care service packages that best meet the need of their citizens. We agree with the need for federal incentives for long-term care insurance, to encourage those who can pay for their own care to do so. We agree with the need to regulate long-term care insurance to We agree with increasing the Medicaid personal needs allowance for individuals in nursing facilities to $50.00, as a modest investment in an improved quality of life for indigent residents. We agree with the need to increase the amount of assets that We agree with the creation of an extended care benefit as part I want to emphasize a couple of those areas of agreement. The centerpiece of the President's long-term care package is an expansive |