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The state of long-term care

January 28, 2011
by Greg Crist, Vice President, Public Affairs, American Health Care Association
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Editor’s note: The following is a guest commentary provided by the American Health Care Association and the National Center for Assisted Living.

Last week, the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) launched an informational series titled The State of Long Term and Post-Acute Care, to coincide with President Obama’s State of the Union address on January 25. By our estimates, 4.4 million of those Americans who watched Obama’s address will require long-term care and other related services at some point in their lives. It is critical that the funding sources, quality programs, and workforce initiatives currently in place continue as these Americans age.

For this reason, The State of Long Term and Post-Acute Care series, divided into five sections critical to our profession, was both timely and appropriate. This compilation of findings on quality, the workforce, post-acute care, assisted living, and reimbursement comprises our own summation of the “state of the union,” which has been recapitulated in the following article.


Logos courtesy of AHCA/NCAL

The State of Quality

The State of Quality features milestones in patient medical conditions, consumer satisfaction, and the commitment to quality by skilled nursing and rehabilitation facilities across America. Among the highlights, the Centers for Medicare & Medicaid Services (CMS) confirmed that nursing homes made measurable quality improvements in 16 of 26 quality indicators between 2000 and 2009, with positive trends continuing in 2010. The statement also shows that facilities had an 85% satisfaction rate among consumers and have been utilizing quality improvement programs more broadly, resulting in improved quality of life for residents. Additionally, more than 500 skilled nursing and assisted living facilities were recognized for their unique and ongoing commitment to quality improvement.

The State of the Long Term Care Workforce

Emphasizing that the demand for long-term care will only increase—with 27 million individuals requiring these services by 2050—the State of the Long Term Care Workforce highlights the need for more career development opportunities and the availability of workforce grants for facilities in all areas of the country. As the Baby Boom generation ages, the demand for long-term care and services will only grow. It is critical that the pipeline of a trained workforce grows with it, since caregivers and staff are the backbone of every facility.

The State of Post-Acute Care

Trends in medical, rehabilitative and therapeutic care services, as well as payment methods, point to the evolution of today’s post-acute care. Recent data from the 2010 Annual Quality Report indicates that more than 50% of Medicare beneficiaries in need of post-acute care following a hospital stay are discharged to a skilled nursing facility, making nursing homes the largest single provider of post-acute care in America. Nursing homes are also treating and discharging patients at a higher rate today than ever before with 39% of Medicare patients returning home within 100 days of admission. It is crucial that White House and other lawmakers recognize the role nursing homes play in American society: to improve patients’ functionality so that they can return home and remain active in their communities.

The State of Assisted Living

With nearly 40,000 residences across the nation, assisted living communities are a viable and welcome option for many older Americans. Assisted living is therefore often the first experience older adults are having with long-term care. As we enter 2011, there are more care options offered than ever before. With residents who, on average, need help with two activities of daily living, assisted living communities across the country strongly embrace the concept of person-centered care. The statement on assisted living communicates how these facilities embrace a care philosophy that meets the social, emotional, cultural, intellectual, and spiritual well-being of older Americans.

The State of Reimbursement

The long-term care financing system—a combination of Medicare payments, Medicaid funding, and other resources—affects nearly all areas of our profession. From the high quality care we deliver every day to the career training we provide, funding and payment systems play a vital role in the sustainability of nursing facilities and assisted living residences. Medicare is often at risk for significant cuts, threatening the delivery of high quality care and services. Our own research found Medicaid—the largest payer of long-term care and related services—was underfunded by $5.6 billion in 2010. America’s long-term and post-acute care providers are the nation’s second largest healthcare employer. Adequate federal Medicare funding in the face of an historic and ongoing state Medicaid funding crisis is essential to preserving both quality care for seniors and good jobs for U.S. workers.

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