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Need for Coverage of In-Home and Community-Based Long-Term Care

Policy Date: 1/1/1990
Policy Number: 9005

The American Public Health Association,
Knowing the growing need for community-based medical and supportive services by Americans of all ages and by increasing numbers of older persons and their families in particular;1-3 and
Knowing that nearly 90 percent of disabled older persons living in the community receive assistance from family members and other unpaid caregivers, the majority being wives, daughters, or daughters-in-law;4 and
Knowing that the care of disabled persons often comes at great emotional, physical, and economic cost to the caregivers and their family, and that national estimates of the amount of unpaid time providing care to the disabled elderly run as high as 27 million days of informal care each week;4 and
Knowing the limits of current public coverage of these services under Medicare, Medicaid, and other government programs;5,6 and
Knowing that the preference of people for coverages for noninstitutional home and community-based care; and
Knowing that other community-based services such as geriatric day hospitals respite care, hospice care, and adult day care centers are becoming increasingly available and represent viable, less restrictive options to permanent institutional care that facilitate and augment informal and family care system; and
Knowing that the numbers of day care centers in the US have increased from 14 in 1970 to over 1,200 today and are the subject of a congressionally mandated study in 1986 into the nature and quality of services provided;7 and
Recognizing that despite efforts by the private sector to provide financial protection against long-term care costs, the availability of private long-term care policies is limited by virtue of cost, and typically restricted in the breadth of coverage; and
Knowing that the lack of state and federal regulation for such policies provides for inconsistent consumer protection;4,8 and
Knowing the growing public support for long-term care coverage and the number of legislative proposals that have been introduced in the Congress and in state legislatures to improve public and private coverage of long-term care;9,10 and
Recognizing that a number of national initiatives, including congressionally mandated commissions and studies have or will soon release proposals that address the need for improved long-term care coverage alone, and in the context of more comprehensive health care reform;11-13 and
Understanding that long-term care includes a broad range of institutional in-home and community-based services and that expanded financial protection and services are needed in each of these areas; and
Knowing that state Medicaid programs must include long-term care but that this coverage and the population eligible for this coverage varies greatly by state; and
Knowing that expanded in-home health and respite care services were passed into law as part of the Medicare Catastrophic Coverage Act of 1988 and, subsequent to the repeal of this law in December 1989, have been reintroduced for consideration by the Congress this session; and
Knowing that APHA is promoting development of a National Health Program and that the program description addresses the need for long-term care services; and
Knowing that the legislative principles governing these long-term care services are not currently specified in APHA resolutions; therefore
1. Supports the expanded coverage of in-home and community-based health and supportive services for persons requiring long-term care of all ages, in the context of the development of a national health program; and
2. Endorses passage of federal legislation that provides for:
● adequate financial protection against the costs of needed long-term care services;
● improved availability and coordination of in-home and community-based long-term care services and broader definitions of covered services;
● a broad definition of health, social, economic, and personal support services;
● a mechanism for case assessment and management of services and periodic reassessment of need, and the equitable payment of such services through public and/or private sources;
● equitable reimbursement of long-term home care providers;
● interrelationships of community-based services to other long-term care benefits, e.g. Medicaid benefits, institutional care and acute care; and
● mechanisms to ensure the quality of services, adequate financing of appropriate services, and protection of the rights of consumers.
1. Rivlin AM, Weiner JM: Caring for the Disabled Elderly: Who Will Pay? Washington, DC: The Brookings Institute, 1988.
2. Friedland B. Financing Long-Term Care. In: McArdle F (ed): The Changing Health Care Market. Washington, DC: Employee Benefit Research Institute, 1987.
3. Office of Technology Assessment: Technology and Aging in America. Washington, DC: OTA, June 1985.
4. Rivlin AM, Weiner JM: Caring for the Disabled Elderly: Who Will Pay? Washington, DC: The Brookings Institute, 1988.
5. Pawlson G: Financing Long-Term Care: The Growing Dilemma. Washington, DC: Center for Aging Studies and Services, George Washington University, 1989.
6. Senate Special Committee on Aging, Developments in Aging. Washington, DC: US Congress Committee Print, 1988.
7. Senate Special Committee on Aging: Developments in Aging. The Long-Term Care Challenge. Washington, DC: US Senate, February 1988.
8. United States General Accounting Office, "Long-Term Care Insurance, State Regulatory Requirements Provide for Inconsistent Consumer Protection," Washington, DC, April 1989.
9. American Association of Retired Persons and the Villers Foundation, poll taken in 1987 of registered voters of all ages.
10. O'Shaughnessy C. "Long-Term Care Legislation: Summary of Selected Bills," Congressional Research Service, Library of Congress, Washington, DC 1989.
11. United States Bipartisan Commission on Comprehensive Health Care, established by law in 1988.
12. US Department of Health and Human Services, Task Force on Long-Term Care Policies, "Report to Congress and the Secretary: Long-Term Care Policies," Washington, DC 1987.
13. American College of Physicians, "Access to Health Care," Annals of Internal Medicine, Vol. 112, No. 9, May 1, 1990.
14. Rabin DL, and Stockton P. Long-term Care for the Elderly: A Fact book. Oxford University Press, New York, 1987.