LTC Bullet:  Long-Term Care Advocacy Shortsighted

Friday, March 29, 2002


*** Center News:  On Sunday, March 31, 2002, the Center for Long-Term Care Financing completes our fourth full year of advocating for rational LTC public policy.  And changes are afoot.  Executive Director David Rosenfeld, JD, MSW is leaving full-time employment with the Center to explore a run for public office and other opportunities to influence public policy.  David will remain involved as a member of our Board of Directors and as a formal adviser to the Center.  Today's Bullet is an editorial authored by Mr. Rosenfeld.  Although the piece addresses LTC policy in Washington State, it could just as well have been written about any and every state in the country.  After you read it, stay tuned for our comments on David's tenure as Executive Director.  Amy Marohn, MS, currently the Center's Director of Marketing and Development, ascends to the role of Executive Director.  If you've interacted with Amy, you know how capable and committed she is to the LTC mission.  If you haven't met her yet, make it a point to "shake hands" electronically at or 425-377-9500 until you can meet her in person at conference sometime. ***

*** As promised in our last Bullet, guidelines for corporate and individual donor-only zone access have been published on our website at  Titles to be added to the "LTC Week in Review" feature in The Zone on Monday include:

"Double Jeopardy on Nursing Home Costs"

"Nursing Home Association Fights Back Against Medicaid"

"Enron-ing LTC"

"Tracking Social Security"

"Nursing Home Liability Crisis Heightens"

Hint:  We commit to post these "LTC E-Alerts" no later than the Monday after we announce them.  But the truth is that we often post them the same day we announce them.  So zone in anytime for the latest news and comment on LTC service delivery and financing. ***

"Long-Term Care Advocacy Shortsighted"

by David M. Rosenfeld

"Our elected officials must provide leadership and the public must offer support for proper funding of long-term care in this state -- now and into the future."  Thus concluded a recent Seattle Times editorial ("Don't Shortchange Long-Term Care," March 6, 2002) by James Roe, President of the Washington Health Care Association (representing hundreds of Washington nursing homes and residential care facilities).  Leadership and public support, according to the editorial, equals more public funding of long-term care across the spectrum of care settings (nursing homes, assisted living, boarding homes, adult family homes, etc.).  Roe advocates not just restoring Governor Locke's proposed cuts in Medicaid reimbursements, but a general increase in public funding to secure the future of our long-term care service delivery system.  "After all," according to Roe, "every one of us will someday need to rely on long-term care services . . . .  We must be willing to make the investment and provide the resources to make certain this care is available when our time comes." 

Is more public funding really the solution? 

Roe is correct that our elected officials should act now.  Pumping more taxpayer dollars into our current system absent critical changes in public policy, however, will do nothing but exacerbate the crisis now facing long-term care providers. 

Washington State spends an enormous amount of money on providing long-term care services through the Medicaid program:  more than $615 million in FY 2000.  Total state Medicaid spending for YR 2000 approached $6 billion.*  The problem is too many people rely on taxpayers to pay their long-term care bill.  Thus, we must encourage more private financing of long-term care (through insurance, savings and investment) so that Medicaid can focus on its intended mandate:  providing care to the genuinely needy.  More public funding will do nothing to achieve this end.  More likely, an increased public commitment will encourage even more people to ignore the risk of long-term care until it's too late to avoid welfare dependency.

Less than 10% of seniors and virtually none of the Baby Boom generation have purchased long-term care insurance or made other arrangements to pay privately for their long-term care.  Why?  Current public policy rewards people for ignoring the risk.  Why pay premiums, save or invest if you can wait to see it you ever need care and get taxpayers to pay the bill?  No, most of your neighbors are not planning years in advance to qualify for Medicaid.  Easy access to public benefits, however, has anesthetized the public to the risk of long-term care and thus very few people plan ahead.  Generous eligibility rules allow most middle class seniors to walk right onto Medicaid. More affluent seniors can artificially impoverish themselves (i.e., transfer or shelter their assets) with the assistance of a professional Medicaid planning attorney.  You've probably seen a mailer, advertisement or billboard hawking Medicaid planning as a way to avoid nursing home bills. 

Wouldn't this situation lead to excessive reliance on Medicaid?  Absolutely.  Seventy percent of Washington's nursing home residents are on Medicaid.  It's no surprise, therefore, Medicaid is struggling to reimburse even the cost of providing care.  This is true not only for nursing homes, but for providers of all long-term care services which Medicaid funds.  There is every reason to conclude, moreover, that increased public funding will make matters worse, not better.  If Medicaid expands coverage (in dollars and services) of long-term care without any changes in public policy, more people will utilize the program's offerings.  Families now struggling to keep a loved one at home precisely because of Medicaid's limited coverage (primarily for nursing home care) will gladly take advantage of expanded access.  Healthy seniors and their adult children will feel even less need to plan ahead to pay privately.  The market for private financing vehicles such as long-term care insurance will evaporate.  The demand for Medicaid planning services will boom.  And taxpayers will look forward to a skyrocketing long-term care bill as Medicaid becomes the payer of first resort for most of Washington's seniors.

Bottom line:  Medicaid should fund high-quality long-term care across the spectrum of care settings.  It could do so without any new taxpayer money if public policy encouraged most people to plan ahead to pay privately and Medicaid could focus on its intended recipients.


The Center for Long-Term Care Financing's "LTC Choice" framework for public policy reform is a worthy place to begin a dialogue on how best to grow the ranks of private payers.  The core concepts of "LTC Choice" are presented in the Center's white paper titled, "LTC Choice: A Simple, Cost-Free Solution to the Long-Term Care Financing Puzzle" which is available to read online at  [Specifically: ]  With the proper incentives in place, the number of private payers will increase dramatically along with the fortunes of the entire long-term care service delivery system.

The Washington Health Care Association should be commended for focusing our attention on the immediate need to address long-term care financing.  Now let's get busy with public policy reform that will actually produce a fiscally viable system capable of delivering high-quality care to everyone.  

[Note:  The WA legislature has since ended its bruising session without cutting Medicaid long-term care reimbursement to the relief, no doubt, of the provider community.  There’s not much time to celebrate, however.  Nationwide Medicare cuts scheduled for October are still looming large while a state budget shortfall of at least $1 billion is already predicted for the next biennium.]

*  J. Christopher Haugen, et al., "Maintaining Long-Term Care:  Washington Demographic and Economic Trends Threaten Access and Quality," The Evans School of Public Affairs, University of Washington, Seattle, Washington, October 2001, p. 6,

David Rosenfeld, JD, MSW, is Executive Director of the 501(c)(3) nonprofit Center for Long-Term Care Financing in Seattle, WA.  He can be reached at or 425-467-6840.

*** David Rosenfeld is an attorney (JD) and a Master of Social Work (MSW).  He combines a mastery of long-term care policy with compassion for aging and incapacitated Americans, whom we are all trying to serve.  For the past four years, David has run the Center for Long-Term Care Financing's business operations, but that's not all.  He's written many of the LTC Bullets.  (And his Bullets often get the best feedback.)  He takes media interviews.  He writes articles for publication.  He publishes letters to the editors of important periodicals correcting misguided articles on LTC.  He wins influential friends in the media, business, and government sectors to our point of view.  Perhaps most important of all, however, David has been our eyes and ears on the inside of the Medicaid estate planning profession.  As a lawyer, he has belonged to the National Academy of Elder Law Attorneys.  NAELA is the trade association of attorneys who artificially impoverish affluent seniors to qualify them for Medicaid nursing home benefits without spending down.  By monitoring NAELA's email listserve, by tracking their periodicals and publications, and by attending their conferences and meetings, David made it easier for the Center for Long-Term Care Financing to report to you in depth on the techniques of and the damage caused by Medicaid planners.  Through LTC Bullets, media interviews, and meetings with government officials, David and the Center have made sure that the powers-that-be know about, and have encouraged them to take action against, all kinds of Medicaid planning abuses.  David Rosenfeld has been and will continue to be a valuable emissary and educator presenting the truth about long-term care to a largely unaware public, numbed by denial.  The Center for Long-Term Care Financing and its followers and supporters will dearly miss David's full-time work and advocacy.  But we look forward to his on-going contributions to and support of the Center and our common mission.  You can reach David indefinitely at 425-467-6840, ext. 3 and  Please send him your well-wishes and appreciation.  ***