Monday, July 8, 2002
*** Update on Hawaii's CarePlus program
which we critiqued in our LTC Bullet published Friday, June 28, 2002, http://www.centerltc.com/bullets/current/367.htm.
Source: "LTC Daily
Analysis Briefs," July 2, 2002, prepared by http://www.eliresearch.com/
for members of http://www.snalf.com/.
"Hawaii Governor Signs Landmark LTC Bill.
HONOLULU, HI, July 3 (Eli Digital) Hawaii
will break new ground with the establishment of the first ever state-run
long-term care program. Gov. Ben
Cayetano this week signed legislation establishing the preliminary framework for
a state-run long-term care system, the Associated Press reports.
The bill instructs the Executive Office on Aging to convene a summit to
present a comprehensive and affordable long-term care system to next year's
legislature and sets up a board of trustees to oversee a state fund.
Hawaii's first lady had pushed for a $10 a month tax on all workers, but
that proposal was not included in the final bill.
Some opponents of the proposal argue that it will undermine President
Bush's efforts to reform Medicare and Medicaid, while others assert that
long-term care should be paid for through private insurance, the AP says."
Despite the spin in this coverage, not much remains of the original
Hawaii proposal. According to
"National Underwriter" at http://www.nationalunderwriter.com/lifeandhealth/hotnews/viewLH.asp?article=7_1_02_20_5715.xml:
"The final version of the bill passed 38-13 in the House and 21-3 in
the Senate. The text of the bill is
on the Web at http://www.capitol.hawaii.gov/sessioncurrent/bills/hb2638_cd1_.htm."
*** Donor Zone bonanza.
Here's some fresh content just posted.
Be sure to take your one-a-day mental vitamins in The Zone.
Call or email Amy Marohn at 425-377-9500 or mailto:email@example.com
to Zone In. Or simply contribute
$100 or more per year to the Center (tax-deductible) at http://www.centerltc.com/support/index.htm
and let Amy know your preferred user name and password (up to 10 characters
each). If you sponsor an LTC Bullet
for $500, we'll throw in one year's individual membership in The Zone.
For information on how to qualify your whole company or organization for
The Zone, jump to http://www.centerltc.com/DOZ_info.htm.
Week in Review July 1 - 5, 2002: LTC
LTC E-Alert #167--WSJ on LTCI
LTC E-Alert #168--Progress on Parkinson's
LTC E-Alert #169--High Cholesterol Risks Alzheimer's
LTC E-Alert #170--Drugs, LTC, and
Week in Review June 24 - 28, 2002:
LTC E-Alerts #162-#166
LTC E-Alert #162--NH Quality in Bankrupt Facilities
LTC E-Alert #163--Online Gerontology Certification
LTC E-Alert #164--Vitamins for Seniors
LTC E-Alert #165--Shellenbarger on Paying Family Caregivers
LTC E-Alert #166--Are Seniors Over-Medicated?
The LTC Reader:
The LTC Reader #22-- Medicare Savvy Pays
The LTC Reader #23--VA Nursing Home and Domiciliary Care
The LTC Reader #24--GAO or Pollyanna:
Who's Right about Social Security, Medicare and Medicaid?
The LTC Data Base:
The Data Base #22--Could Home Equity Conversion Fund LTC and LTCI Premiums?
The Data Base #23--Global Aging
The Data Base #24--Doctor Visits and Costs Rising with
Spend 5 or 10 minutes per day in The
Zone to stay on top of developments throughout long-term care. ***
LTC BULLET: THE
HISTORY OF LONG-TERM CARE
we've recounted many times before, America's long-term care system is a mess:
nursing home bankruptcies, slow assisted living fills, collapsed stocks,
scarce capital, institutional bias, doubtful quality, high cost, staff
shortages, low government reimbursements, little private LTC insurance,
skyrocketing liability premiums, etc.
said: "If we could first know
where we are and whither we are tending, we could then better judge what to do
and how to do it." (House
Divided Speech, 1858) Before we can
look forward to a solution successfully, we should look backwards and ask
"How did long-term care come to be the way it is today?"
and publisher Karen Stevenson Brown has undertaken to write the history of
long-term care service delivery and financing.
She's posting the work in progress at http://www.elderweb.com/history/.
The results so far are fascinating.
Here's an article by Ms. Brown introducing the project and a few excerpts
to spur your interest.
"History of Long Term Care"
by Karen Stevenson Brown; http://www.elderweb.com/history/
This new section of ElderWeb is a
comprehensive overview of how our long term care system has evolved by examining
the events and decisions that changed the way that we have provided and paid for
the care of our elderly over the years.
My goal in this project is not to
create a simple chronology of events, but to identify causes and effects - why
did things turn out the way they did? For
instance, back in Colonial times, older people were generally cared for by their
families. That changed when
children started moving away from the family home in the 19th century as they
went into the cities and out to the West. Urbanization
had a big impact, too. City
families were smaller (there were fewer children who could eventually provide
care), city homes were smaller, especially the tenements, and there was no way
to maintain gardens or livestock in the city, and city jobs were different (it
was harder for an older person to find work in order to be self-supporting).
My approach has been to investigate
events that happened in each time period, but also to work backwards to try to
identify the catalyst for changes in the type of care we provide or the way we
pay for it. Why did CCRC's emerge
in the 1960's and assisted living in the 1980's and 1990's?
Why did the nursing home industry end up dominated by for-profit
companies? Why did we end up with
70% of nursing home residents on Medicaid?
Why doesn't Medicare cover nursing home care? Why were the poor farms created, and why did they disappear?
I believe that understanding what has
happened in the past, and why, is critical to understanding why our system works
the way it does, and planning for its future.
Certain themes re-appear over and over.
The government creates a new source of funding, everyone piles in to take
advantage of it at the expense of programs the government does not pay for,
costs explode to levels far beyond initial projections, we try to find the
"culprit" for the cost over-runs, the program is scaled back or
saddled with burdensome restrictions that start to deny service to even the most
deserving, then we have to find a new way to help the under-served.
We'll keep making the same mistakes if we don't stop and look back from
time to time to try to understand what went wrong and what went right.
[LTC Comment: Right on!]
It is an enormously interesting
project. I've spent nearly 20 years
in this field, including 9 years working with the ElderWeb web site and
newsletter, 9 years as the CFO of a nursing home chain, 6 years doing finance
and technology consulting to providers, and personal experience helping family
members and friends with their own problems, and I never knew many of the things
I've discovered in the last few weeks.
Some tidbits from the information
posted so far:
- In colonial days, "old age
security" meant having children and/or property.
Old men and women who had no children to care for them and no money had
few good options available.
- The first "institution" for
the poor elderly was the poorhouse, where "inmates" had to give up all
their rights. It was like a prison,
inmates couldn't leave or have guests without permission. They were even forbidden to wear their own clothes -- they
had to wear a uniform. Many of the
elderly shared space with the mentally-ill, who were sometimes chained and kept
in pens or stalls.
- "Benevolent Societies"
created one of the first organized old-age assistance programs. Members paid monthly dues to the Society while they were
young and healthy, then received help when they were elderly, infirm, or in
- "Old age homes" were
developed during the 1800's to protect "respectable" people from the
"indignity" of the poorhouse. Some
of them required the recipient to pay an up-front fee and turn over whatever
income and assets they had in exchange for a guarantee that they would have a
home as long as they liked -- an early version of what we now call "lifecare".
- Early retirement communities were
also developed during the 1800's. One
had "convenient two-story brick cottages", a community center, a
hospital, and its own water system.
- While fewer people lived to age 65 or
age 85 in 1900, those that did had nearly as many years ahead of them as people
of those ages do today. There were
reports of hundreds of people who lived past 100.
- Urbanization and the migration to the
west in the 18th and 19th centuries reduced family sizes and disbursed families
so that older people could not count on having a family member available to care
for them, increasing the need to develop alternative solutions.
You'll want to read the story online so
you can see the photographs of poorhouses and old age homes of the time.
You'll also want to take a look at dozens of interesting pictures,
narratives, graphs, and charts collected in the appendix, many from the
wonderful Library of Congress American Memories collection.
author's contact information is as follows:
Stevenson Brown, Publisher; ElderWeb; 1305 Chadwick Drive, Normal, IL 61761;
Phone: 309-451-3319; Fax: 866-422-8995; firstname.lastname@example.org;
Regarding the content on her website, Ms. Brown states: "Feel free to link to this material or let others know it exists, however these pages include copyrighted material that took a long time to create, so please do not copy it without permission!"