COVID-19's horrific toll on nursing-home and assisted-living residents, their families, and workers is a clarion call for finally transforming long-term care — also known as long-term services and supports (LTSS). Provided in homes, assisted living facilities and nursing homes, LTSS help people do routine daily activities such as bathing, dressing, preparing meals, and administering medications.
If our post-COVID-19 world embraces the status quo, we'll fail generations of people in need. We must provide a Medicare benefit that helps provide LTSS in more people's homes, preserves one's money if nursing home care is needed and integrates LTSS with acute care to improve health.
As a kid, I helped provide home care for my grandmother until she died. I saw my other grandparents live in assisted living and then a nursing home. In adulthood, I worked in LTSS for more than a decade. Little about LTSS has changed in my lifetime. That's the problem, especially when historic levels of people need help.
The best LTSS improve health outcomes. They can help stave off depression, ensure medication compliance and provide good nutrition. LTSS help keep people out of costly hospitals, assisted living and nursing homes, which can be infection hotbeds. Most people think Medicare pays for LTSS. It doesn't. An AP-NORC Center for Public Affairs Research survey shows more than half of Americans age 40-plus think it should.
Adding a Medicare LTSS benefit for Americans would cost money, yet save it in other places through fewer hospital and nursing home stays. It's worth it to improve people's lives and dignity. Former U.S. Sen. David Durenberger of Minnesota had a pathway to a Medicare benefit that combined the Social Security Supplemental Disability benefit, a Medicare catastrophic benefit, and a 14- to 18-month private insurance benefit. Unfortunately, there's been no national coalition built to change how we pay for care. That must change. And Minnesota could be the pilot state to show America how it could work.
Payment for LTSS falls fully to seniors and their families, driving many into Medicaid and poverty. According to a Health Affairs analysis, half our population can't pay for LTSS. U.S. Sen. Amy Klobuchar, who highlighted LTSS during the Democratic presidential debates — a first — could bring Democrats and Republicans together on this issue, especially if she has a new presidential partner who desires to raise human dignity and reduce inequities by forging a caring nation.
Medicare must also pay for an integrated health care system where hospitals, clinics, and LTSS are closely connected and reimbursed based on improving lives, not simply providing more services. Today's care — especially for older adults — is frequently a costly, exhausting ordeal. It needn't be.
Take, for example, 91-year-old Mary, who falls at home due to a urinary tract infection, a condition that could have been identified with early intervention. Her daughter finds her writhing in pain. A 911 call brings firemen, followed by an ambulance trip to the emergency room, a hospital stay, and then discharge to a nursing home rehab center. Instead of getting stronger, this circular journey weakens her and might even inflict other infections.
We should stop this health care hamster wheel through an earlier telehealth visit with a physician or nurse practitioner who knows Mary and her medical history. A follow-up visit to Mary's home could prescribe LTSS interventions, such as home modifications, food delivery and in-home physical therapy. All proactively help Mary be where she most desires to live and die — her home.
The Commonwealth Fund found that a Johns Hopkins hospital-at-home initiative raised patient and family satisfaction levels, cost 32% less than hospital care, and greatly reduced delirium and other complications. Other programs show similar results.
Such care should be the norm, sharing cost savings with LTSS workers who keep patients out of the hospital. Rewarding these workers for contributing to better health and a better death would draw people we want caring for us — not criminals. We could also draw these workers by starting a statewide apprenticeship program that provides a solid pathway for a caregiving career.
Moving to integrated health care, we must eradicate nursing homes that stuff two people into a room separated by a curtain. Such "homes," with their shared bathrooms, are virus cesspools that treat people like cattle. If we can build Taj Mahal orthopedic centers, we can eliminate these dated dumps.
Rapid telehealth adoption is a silver lining to COVID-19. It must stay. Minnesota could be a global development hub for new independence and safety technology. Best Buy — whose staked a strategy on aging — could join the University of Minnesota to attract inventors and have users vet technology. Best Buy gets a proven product, the U gets a portion of proceeds, entrepreneurs get shelf space, Minnesota gets new economic development, and, best of all, people get life-improving technology.
We often talk about "the health care system." It doesn't exist. We must end this fragmented failure and reinvent LTSS to build the right care in the right place at the right time.
Eric Schubert, of West St. Paul, is a communications professional and former Humphrey Institute Policy Fellow.
