LTC Bullet:  The Paul Revere of Assisted Living


Tuesday  March 27, 2001



The March 2001 issue of "Assisted Living Today" magazine contains a slightly abridged letter to the editor by Center for Long-Term Care Financing President Stephen Moses.  The full-length version of Steve's letter which echoes a warning to the assisted living business follows below.

We strongly encourage LTC Bullets readers to learn more about each other's sectors of the long-term care profession.  A very good way to do that is to subscribe to the trade journals, which cover various aspects of long-term care service delivery and financing.

To subscribe to "Assisted Living Today," call 703-691-8100.  For more information on the Assisted Living Federation of America, which publishes this magazine, see

Dear Editor:

Thank you for publishing Ken Burgess's article "Everything Old Will Be New Again" (ALT, Nov-Dec 2000).  I nominate Burgess as the "Paul Revere" of assisted living.  He raises the alarm that an army of well-intentioned, but ill-advised government officials and senior advocates is on its way to attack the profession of assisted living.  Burgess's argument is sound that government financing through Medicaid and/or Medicare may lead to excessive regulation and ultimately cause reduced access and quality.  Exactly that already happened to nursing homes.

Does it seem paradoxical that supplemental financing and strong regulation by the government could injure consumers?  Not if you understand the history of the nursing home profession!  I tried to explain this issue and resolve the paradox last year in an article for Assisted Living Today titled "Equal Access for All" (ALT, June, 1999).  This letter has no room to revisit that argument.  For a very detailed treatment of the subject, however, see our white paper "LTC Choice:  A Simple, Cost-Free Solution to the Long-Term Care Financing Puzzle" and my speech "The Fall and Rise of Long-Term Care," both of which are published in .pdf format on the Center for Long-Term Care Financing's web site at

During the past several months, the Center for LTC Financing interviewed 119 of the leading financiers, providers and insurers of long-term care.  We asked them why America's long-term care service delivery and financing system has become such a tragic mess.  Their answers were unequivocal.  For example:  "Medicaid does not cover costs" . . .  "There is no question the nursing home sector was killed by Medicare cuts." The government demands "Ritz-Carlton care for Motel 6 rates" and simultaneously enforces an ''unprecedented regulatory Jihad."  The Center's latest report, published December 7, 2000, contains over 60 pages of similar quotes and analysis.  This report, "The LTC Triathlon: Long-Term Care's Race for Survival" is also posted at

I share Ken Burgess's opinion that assisted living needs to remain a mostly private-pay service for the time being.  I also understand the need to make the assisted living alternative affordable to more middle and lower-income Americans.  That goal is eminently achievable without sacrificing the assisted living profession's independence from excessive government financing and regulation.  The secret is to empower more Americans to pay privately for the level and quality of long-term care they prefer.  To achieve this goal, however, will require major changes in public policy designed to encourage the public to take the risk of long-term care seriously and to plan, save, invest or insure fully against that risk.  The Center's "LTC Choice" plan is designed to do exactly that. 


It takes courage to challenge the conventional wisdom that long-term care needs more government financing and stronger regulatory controls.  Ken Burgess is a brave pioneer in this regard.  Unfortunately, we often identify the pioneers by the arrows in their backs.  That's why I wanted to point your readers toward the work we've done that tries, calmly and thoughtfully, to lay down the reasoning which supports his articulate and rightful alarm.

*** Forward freely; encourage subscribers! ***

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