One way to reduce U.S. long-term care (spending) would be to make sure that chronically ill people who are in nursing homes get a decent level of care.
Judith Feder, a Georgetown University health policy expert, made that case at the hearing on LTC financing that was convened last week by the Senate Special Committee on Aging.
Feder spent some time at the hearing questioning whether private long-term care insurance (LTCI) can ever be affordable enough and popular enough to do much to help the United States deal with aging of the baby boomers.
John O'Brien, the director of the U.S. Office of Personnel Management, talked about the federal government's own voluntary LTCI program, and Sen. Mark Udall, D-Colo., expressed guilt about not getting around to looking closely at his own LTCI program brochure.
About 58 minutes into the hearing, Feder looked a little exasperated and suggested that, if the United States really wants to get down to the basics of controlling LTC costs, it has to do something about the quality of nursing home care and coordination of care for nursing home residents.
Feder questioned the premise that Medicare is necessarily any more wasteful or more expensive, on an apples-to-apples comparison basis, than the rest of the U.S. health care system.
"The whole system isn't controlling health care costs," Feder said. "If anything, Medicare is doing slightly better."
But the most expensive Medicare patients are those who need both long-term care and care for 5 or more chronic conditions, and one obvious way to reduce the cost of those patients' care is to make sure they're getting the right care, Feder said.
"We have tremendous evidence of inappropriate, unnecessary and potentially preventable hospital use by long-term care nursing home residents who are not getting enough nursing care in the nursing home," Feder said.
In some cases, nursing homes are not even keeping the residents from becoming dehydrated or moving nursing home residents often enough to keep them from developing bedsores, Feder said.
Congress also could help by keeping nursing homes from going to state legislatures to wrestle money away from community-based programs, Feder said.
"Nursing homes have a great deal of political power in the states," Feder said.
Nursing homes are important for some patients, but most people want to stay in their homes as long as possible, and one way to make that possible is to improve funding levels for programs that keep people at home, Feder said.