Annals of Long Term Care

Lawmakers continue to debate the politically-charged issue of prescription drug coverage for seniors. The U.S. House of Representatives, on a near party-line vote of 221-208, approved a GOP-backed $350 billion Medicare reform package on June 28. House Democrats strongly oppose the Republican prescription drug plan contained in the bill and introduced their own 10-year drug benefit plan estimated to cost between $800 billion and $1 trillion. However, the GOP leadership blocked Democrats from offering their proposal on the House floor.

At press time, the Senate was expected to consider a drug plan in mid-July, though it was unclear which proposal they would take up. Bob Graham (D-FL), Ted Kennedy (D-MA), and Zell Miller (D-GA) introduced legislation (S. 2625) in June that is generally favored by Senate Democrats; the group of senators dubbed the "Tripartisan Group," including Republican Charles Grassley (R-IA), Democrat John Breaux (D-LA), and Independent James Jeffords (I-VT), unveiled their own plan in July. Right now, the prospects for final passage of a prescription drug benefit are uncertain as both parties jockey for political advantage in an election year.

Senate Aging Committee Releases Long-Term Care Findings
Following 13 hearings on long-term care, the Senate Special Committee on Aging released findings on June 20 summarizing the recommendations of the many government officials and outside experts who have testified before the committee on the nation’s long-term care crisis. The new report calls this country’s current financing policies “unsustainable” in coming decades, particularly in light of the additional strain the health care system will experience once 77 million baby boomers hit retirement age. Without reform, changing demographics will force nearly 75 percent of all federal revenue to be spent on Social Security, Medicare, and Medicaid by 2030, the report said.  

To address the problem, governors and other witnesses testifying before the committee argued that money could be saved if Medicare and Medicaid dollars were combined in order to avoid duplication or delay in services, a common occurrence in those considered “dual eligible.” Other savings could result by using Medicaid and Medicare funding to pay for preventive care, with a goal of delaying institutionalization, the report noted. Governors have also creatively used the Medicaid waiver process to increase home and community-based services for the elderly and disabled.

In addition to financial concerns, the report highlights other issues important in meeting the needs of aging baby boomers, including addressing workforce shortages. In particular, the report states:  “The number of health care professionals with specific geriatric training is not keeping pace with the changing demographics.” Moreover, while all 125 of the nation’s medical schools have a pediatrics department, only three medical schools have a geriatrics department, the report said, noting that many experts have recommended an increase in the number of specialized physicians, nurses, and other health care professionals trained in geriatrics. “However, we are currently a long way from having an established cadre of trained practitioners: At the current time, Medicare supports almost 100,000 medical residency/fellowship positions but only about 300 are in geriatric medicine.”

The report, Aging Committee: Hearing Finding Summary, is available on the committee’s website at: http://aging.senate.gov/events/ltc.pdf.
 
AGS Member Testifies on Elder Justice
AGS member Carmel Dyer, MD, testified before the Senate Finance Committee June 18, at a hearing on “Elder Justice: Protecting Seniors from Abuse and Neglect.”  Dr. Dyer appeared before the committee on behalf of the Texas Elder Abuse and Mistreatment (TEAM) Institute in Houston.