Personal responsibility urged for long-term care

13 Feb 2008 // Steve Moses rode his Airstream trailer, dubbed "The Silver Bullet," into Nashville last week with this message: The solution to a looming long-term care crisis is in consumers' taking personal responsibility, not in more government programs.

The stopover by Moses, president of the Seattle-based Center for Long-Term Care Reform, was part of his National Long-Term Care Consciousness Tour, which kicked off in December.

It comes amid efforts in the state and nation to expand long-term care options and services.

Gov. Phil Bredesen recently proposed spending $12 million to expand home- and community-based care options across the state.

The Centers for Medicare and Medicaid Services will take comments through Tuesday on a proposal to give Medicaid beneficiaries a cash allowance to help pay for personal-care workers who would prepare meals and do other chores for patients in community settings or at home.

With 77 million baby boomers near retirement and about to collect Social Security benefits, Moses sees a fiscal crisis at hand. He believes that the public is in denial because of a system that has seen the federal government shoulder most long-term care costs for decades. Medicaid, in fact, rates as the biggest payer.

Moses said more of that burden is about to shift to individuals. "You're going to be responsible, so you better plan," he said. More seniors probably will have to use some of the $4.2 trillion of equity in their homes to pay for care, perhaps through such financial tools as a reverse mortgage.

Moses' ties criticized

Moses' campaign for private solutions to long-term care has drawn some critics, who say he has ties to insurers that stand to benefit by selling long-term care products.

"You can't actually maintain that you're an independent expert while your hand's stretched out to the industry," said Naomi Seligman Steiner, deputy director of Citizens for Responsibility and Ethics, a nonprofit group in Washington, D.C.

Moses said he accepts sponsorships from long-term care insurance companies but said his primary goal is to preserve Medicaid as a safety net for the poor.

Marilyn Wilson, a TennCare spokeswoman, said Tennessee's long-term care system is far behind other states' and needs to be restructured so Medicaid enrollees have more cost-effective options.

A joint legislative committee has been studying ways to make changes and hopes to have its report ready by the end of April, said state Rep. Dennis Ferguson, D-Harriman, who heads that effort.

Several bills are pending in the legislature, including one that would require the state's health commissioner along with the Commission on Aging and Disability to submit a plan to rebalance long-term care services among nursing homes as well as other home-based and community-based services.

One idea that Moses supports is a plan by the state to join the Long-Term Care Insurance Partnership, a national program that gives consumers incentives to buy private insurance.

"The public has an entitlement mentality," Moses said. "They're not worried about it. That's why it's so tough for the folks here who actually try to sell … long-term care" to them.