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LTC Bullet:

How to Unleash Long-Term Care Insurance and Assisted Living

June 15, 1999


"Assisted Living Today," the premier trade journal of the booming assisted living movement, published an "op-ed" entitled "Equal Access for All" by Center for Long-Term Care Financing President Stephen Moses in the magazine's June 1999 issue.

Moses' article answers the question: "How can we create an incentive strong enough to persuade the financially able to take responsibility for their long-term care so we can save the publicly financed programs for those who truly need them?"

Two extended excerpts follow. To obtain the full article, contact the Assisted Living Federation of America (ALFA) at or 703-691-8100. Single issues of Assisted Living Today are available for $4.

"The United States is the wealthiest nation in the history of the world, yet its long-term care system is struggling. A seamless web of caring services for ailing seniors is desperately needed, but, for some reason, the country has failed to enable all Americans to obtain quality long-term care in a desirable setting at the most appropriate level of care.

"Most opinion leaders, policy makers, and legislators are puzzled by the problem and stymied by the solution. Does the answer lie in greater individual responsibility and reliance on the marketplace? On more social responsibility and public financing? Or is the solution some kind of partnership between the two?"

"The nation's long-term care problems are self-inflicted through counterproductive public policy. Our financing system anesthetizes the public to long-term care risks and rewards failure to save or insure for those risks by providing free or highly subsidized nursing home and home care. Generous public financing of long-term care impedes the development of a private market for geriatric care management, home care, assisted living, and long-term care insurance.

"The solution is to remove perverse incentives in the current public policy that discourage responsible behavior and reward thoughtlessness. Specifically, aging Americans need to be confronted with the reality of long-term care risks when they are still young, healthy, and affluent enough to save or insure against these risks. A public financing system should be implemented that guarantees every American access to quality care at the appropriate level in the private marketplace, but requires the quid pro quo that financial assistance in obtaining such care constitutes a dollar-for-dollar spend down of one's estate assets payable after death. Only with this kind of system can an incentive be created that is strong enough to persuade the financially able to take responsibility for themselves so that publicly financed programs can be saved to serve those who cannot provide for themselves.

"With the proper incentives in place most Americans will plan early, insure fully, and pay privately for assisted living. With most people protected in this way, Medicaid will be able to afford full and fair financing of assisted living for those relatively few families who still fall into the social safety net."