No More "Nice Doggie"

We need a big rock to get long-term services and supports included in health reform. All of us need to think of ourselves as diplomats. Not a day goes by that members don’t write to tell me how difficult it is to provide quality care with inadequate resources and oppressive regulations.

“Several of us are getting overwhelmed with the amount of new regulations and how hard it is to get resources to meet them,” a member wrote yesterday.

Caregivers call me as well. A long-time AAHSA staff member recently experienced a problem with her mother who needed help transitioning from specialized rehab to her home, but found the maze of alternatives difficult to navigate. “I finally know how it feels to be a person trying to figure out a system that is not very consumer-friendly,” she wrote on Friday.

Hundreds of advocacy groups from aging-services organizations and others serving younger populations with disabilities have coalesced around the importance of making sure the services you provide are included in health care reform. Moreover, many well-known academics are concerned about the problems and the need for a national solution to it.

The National Governors Associations, whose members bear the brunt of the Medicaid crisis, recognize the unsustainable dilemma in their policy position on health care reform:

“Develop a sustainable financing mechanism for long-term care services and supports for an aging and disabled population, regardless of income. While states and localities have worked for decades to improve the availability of quality long-term care services and supports, an increasingly disproportionate share of the financing is being thrust onto state Medicaid programs. It is clear that Medicaid cannot be the financing mechanism for the nation’s long-term care costs as baby boomers retire and people are living longer. The federal-state partnership must be employed to redesign our approach to financing and provision of services. While administration of long-term care services and supports by experts at the state and local levels could continue, states and the federal government must work together to modify the federal financing stream to adjust federal payments for changes in demographics.”

Yes, health care reform is a touchy subject — and within health care reform, long-term services and supports are touchier still. Why? Several reasons: legitimate differences of opinion, fear of change, powerful and greedy self-interests, ideologies, and ignorance about the issues.

In the past, there was not sufficient political will to change. So, the politicians tended to wring their hands.

There is no question that transformation is needed. We have the most expensive health care in the world but lag behind many countries in quality outcomes. And long-term services and supports within this predicament are often low on the priority list, and get fewer resources. There is less attention to the growing needs of older adults and people with disabilities.

For about a year now, many key advisers and political leaders have said political will is fueled by public opinion and true political leadership. Today, we may well be witness to two emerging phenomena: a new public will and new political leadership, including President Obama, Sens. Max Baucus (D-Mont.) and Edward Kennedy (D-Mass.), and key members of the House of Representatives, including Rep. Henry Waxman (D-Calif.) and John Dingell (D-Mich.).

The Senate Committee on Health, Education, Labor and Pensions (HELP), which Sen. Kennedy chairs, has put forth a health reform plan that includes a fiscally sound approach to long-term services and supports. The plan would create a national insurance model in which money follows the person, allowing family caregivers to fulfill their noble responsibility. We should support the HELP committee’s provisions on long-term services and supports.

A plan from Sen. Baucus will be on the table soon and will likely have provisions to update Medicaid and Medicare.

When put together, the Baucus and Kennedy approaches transform what we do and may just save Medicaid from the train wreck it faces.

So, today, we have political leadership. However, these forward-thinking leaders need a “big rock.” The big rock of public opinion. We’ve done polling that clearly supports the view that our approach would be well-received because it helps people directly and supports family responsibility. Numerous editorials also reflect a growing national view.

But polling, alone, is not enough. A senate leader asked us over a year ago, “If these issues are so important, why doesn’t my phone ring?” We took that to heart. In the last several weeks, you and several colleague advocacy groups have made phones ring in the Senate by the thousands. We must do it again…and again!

This Thursday, we will sponsor our third Congressional Call-In Day. Beginning at 9 a.m. Eastern, please make a call toll-free to (866) 281-7219. The system will ask you to say your state name and then transfer you to one of your senators. When you get through, tell your senator that the inclusion of long-term services and supports in health reform is a must for both you and the people you serve. We are asking those of you who live in the congressional districts of selected House of Representatives members to call a different number, which I emailed to you yesterday.

This is Democracy in action. The big rock!

You see, our big rock is people like Gene Shuttlesworth, a resident at The Village of Heritage Point in Morgantown, W.Va. The Village’s executive director, Daphne Schreiber, created a major resident advocacy event around our last call-in. She reported on Gene’s involvement:

“All day long, people were passing each other in the hallway saying, ‘have you made your call yet?’ One resident, Gene Shuttlesworth, said, ‘In my short lifespan, that’s the first time I’ve ever made an official call to Washington.’ This gentleman is 92!”

Mr. Shuttlesworth, it is never too late.

We need you, and thousands more like you, to do it again. You’re the “Big Rock!”