Whereas well over 9.4 million adults receive long-term
care in the United States;
Whereas long-term care refers to a broad range and network
of health and social services that are used by persons who cannot care for
themselves because of a physical, cognitive, or mental disability, or a
combination thereof;
Whereas long-term care may involve assisting an individual
with dressing, bathing, transportation, and medication management or
therapeutic and medical services;
Whereas 80 percent of long-term care now occurs in the
home and is accompanied by community services such as Adult Day Care Programs,
home-delivered meals programs, mental health services, and training programs
for family caregivers;
Whereas many informal caregivers are in the
sandwich generation
, which are middle-age people who are
simultaneously caring for children and older family members;
Whereas family caregivers sometimes endure emotional and
physical stress, and make significant financial and career sacrifices to
provide long-term care;
Whereas the vast majority of the sandwich
generation
and caregivers of all ages are women;
Whereas most long-term care health workers are also
women;
Whereas home health aides are largely low-income women of
color with families, and perform a variety of medical and personal services
that are vital to long-term care;
Whereas home health aides are not subject to national
standards or covered by the Fair Labor Standards Act, which contributes to
variations in competency, education, and staff shortages;
Whereas the number of people who are in need of long-term
care is expected to grow due to the Nation’s large aging population, longer
life spans among the chronically ill and disabled, and higher incidence of
acquired disabilities from unmanaged conditions such as heart and respiratory
disease, obesity, stroke, and diabetes;
Whereas there is a serious lack of long-term care
facilities and services for people with mental disabilities;
Whereas, although long-term homecare plays a strong role
in the way that care is received and provided, there has never been a
comprehensive national plan for long-term care, particularly regarding homecare
and community services;
Whereas the last time that Congress comprehensively
reviewed policy options for long-term care reform was nearly two decades ago,
under the United States Bipartisan Commission on Comprehensive Health
Care;
Whereas more information is needed about the use and need
for long-term care services, especially among children and people residing in
rural areas;
Whereas the limited data on the use and need for long-term
care hinders the development of a targeted strategy to address the disparities
in routine access to quality long-term care in the home and surrounding
community;
Whereas a significant portion of formal long-term care
costs are financed with personal funds;
Whereas this method of payment potentially poses economic
burdens that can result in financial ruin, including medical bankruptcy;
Whereas the largest public payer for long-term care is
Medicaid, which allows States to enforce strict requirements for eligibility,
and discourages some Medicaid recipients from acquiring a higher income for
fear of losing Medicaid benefits;
Whereas although most prefer to receive long-term care in
their homes and communities, the majority of Medicaid long-term care
expenditures finance institutional care;
Whereas mentally and physically disabled persons who
require long-term care are more likely to be poor than people who are not
disabled;
Whereas income typically decreases after
retirement;
Whereas people 85 and older have the highest probability
of being low income among the elderly, and the highest probability of requiring
long-term care services;
Whereas these financial realities make it difficult for
patients to pay for long-term care or purchase long-term care insurance;
Whereas persons who buy long-term care insurance are more
likely to have an above-average income;
Whereas there remains a severe lack of national standards
in quality and certification in many facets of long-term care, particularly
homecare and community services; and
Whereas there is no national standard for adult day care,
a community service that is used by people who have mental disabilities, or who
have physical disabilities from conditions such as HIV/AIDS, respiratory
disease, and stroke: Now, therefore, be it
That the House of
Representatives—
(1)commits to integrating long-term care,
particularly as it relates to homecare and community services, into a
comprehensive health care reform agenda because of its important role in the
present and future success of the United States health care system;
(2)regards preventative health and the
management of chronic disease as essential components in decreasing the future
dependence on long-term care by preventing conditions, such as heart and
respiratory disease, diabetes, HIV/AIDS, stroke, and obesity, from becoming
permanently debilitating or disabling;
(3)recognizes the need to collaborate with
local, State, and Federal health care entities to improve working conditions
and training for home health aides, a profession that is a crucial part of
long-term care with the intention of lowering turnover rates, staff shortages,
patient abuse, and raising the standard of care;
(4)recognizes the need to adequately fund and
support existing technologies, entities, and initiatives that assist informal
care givers, and help maintain and improve long-term health services for the
disabled and elderly, such as the Older Americans Act of 1965 (Public Law
89–73), Social Services Block Grants, and the Department of Housing and Urban
Development programs;
(5)recognizes that Medicaid and
out-of-pocket-spending, the dominate methods for financing long-term care,
exclude countless persons from receiving health care service which can lead to
more costly and invasive medical interventions, and that alternative payment
options should be widely available and more accessible; and
(6)commits to aiding relevant parties in
composing, executing, and enforcing a well-informed national strategy for
long-term care that will address geographic and economic disparities that limit
access to care, expand long-term health services, and streamline quality
measures.