REPORT: The Index of Long-Term Care Vulnerability

Featured, Health & Welfare — By on January 15, 2014 at 1:24 PM

Executive Summary

Long-term care (LTC) for the elderly is already a large risk and expense for private citizens and public programs. The need for and cost of LTC will increase radically with the aging of the baby-boom generation. Most expensive long-term care, including care provided in nursing homes or by professional aides in family homes for more than nominal durations, is paid for by Medicaid, a means-tested public assistance program.

Medicaid already strains federal and state budgets, including New Jersey’s. Yet major initiatives at the federal level and in New Jersey are underway to expand Medicaid coverage in general and to make the program’s LTC benefits more attractive, accessible and efficient. New Jersey’s “Comprehensive Medicaid Waiver” aspires to achieve those goals by rebalancing care from mostly institutional services to mostly home and community-based services and by turning over management of long-term care for more recipients with higher acuity care needs to managed care organizations.

New Jersey faces multi-faceted long-term care problems including (1) a rapidly increasing elderly population with (2) much higher numbers of disabled or demented people coming soon and (3) Medicaid already strained as the principal LTC payer dependent on (4) funding from the heavily indebted federal government as supplemented by (5) state revenues constrained by recessionary pressures and poor future economic prospects with (6) very little private financing of LTC to relieve the budgetary pressure on public programs in the context of (7) heavy public dependency on social programs already and a growing “entitlement mentality” among the citizenry.

By focusing on improving the state’s current long-term care service delivery and financing program instead of taking into account this full range of problems and addressing it, New Jersey runs the risk of modifying a broken LTC system that cannot survive the larger on-coming demographic, economic and social challenges. This report offers a way to take account of these broader challenges by applying an Index of Long-Term Care Vulnerability. It recommends that New Jersey reassess its current LTC initiatives and move in the direction of reducing dependency on public programs while attracting much more private revenue into the LTC financing mix.

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