Little Hoover A Bust On Long-Term Care

MAY 11, 2011

By K. LLOYD BILLINGSLEY

California needs new bureaucracies and a “champion” to oversee long-term care under Medi-Cal, according to A Long-Term Strategy for Long-Term Care, a recent report from the Little Hoover Commission, a state watchdog agency. Those and other strategies won’t work, according to Steve Moses, author of a different study.

“Reorganizing, creating new bureaucracies, or appointing a ‘long-term care Czar’ won’t help,” said Moses on Tuesday, in testimony to the Senate Human Services Committee.

Moses heads the Center for Long-Term Care Reform in Seattle and is the author of Medi-Cal Long-Term Care: Safety Net or Hammock? released this year by the Center and the Pacific Research Institute, CalWatchdog’s parent think tank.

Moses testified that the Little Hoover Commission report left him “a little puzzled by what that report includes, and even more so by what it leaves out.” The report, he said, “attributes California’s catastrophic long-term care service delivery and financing problem to inadequate central planning.”

The three major recommendations of A Long-Term Strategy for Long-Term Care are to create a new state department,  pursue “visioning and strategy-building” to “create a seamless continuum” of care, and find a long-term care “champion.”

Baby boomers will soon be retiring in huge numbers, and like current retirees many will be looking to Medi-Cal for long-term care. But according to Moses, “Medi-Cal is finished as the dominant payer of long-term care in California.”

Medi-Cal, he testified, is a public-assistance program, and not suitable as the dominant payer for long-term care. The cost of Medi-Cal is “bankrupting the state” by allowing the wealthy and middle class to exploit a program intended for the poor.

“California has a plague of so-called Medi-Cal planners, attorneys and other financial advisors who artificially impoverish clients to qualify them for Medi-Cal benefits using techniques such as trusts, transfers, ‘Medi-Cal friendly’ annuities and ‘life care’ contracts.

Moses added that “by making long-term care basically a free publicly provided good, the state of California has anesthetized consumers to the risk and cost of long-term care.  People don’t worry about LTC until they need it.  Then it’s too late to save, invest or insure.”

Some Californians still  prefer to pay their own way, Moses testified, because “Medi-Cal has such a poor reputation for problems of access, quality, reimbursement, discrimination, institutional bias and loss of independence, that some people are willing to pay privately for quality home care.”

Public officials can recognize those realities and preserve a “much smaller safety net program,” Moses said. “Or you can ignore the problem, watch the system fall apart, and end up with the same attenuated public system by default.”

His recommended reforms included establishing “the principle that long-term care is a personal responsibility, not a social right.” He wants to “identify and eliminate policies that encourage public dependency.” California should “get out of the way of private markets. Encourage private-sector sources of financing such as greater asset spend-down, estate recovery, home equity conversion, and private long-term care insurance.”

Moses warned the California senators about continuing the current course under Medi-Cal.

“If you keep doing what you’ve always done, even if you do it marginally better, you’ll keep getting the same result,” he testified. “Expecting otherwise is Einstein’s definition of insanity.”

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  1. Maggie Dee
    Maggie Dee 13 May, 2011, 03:34

    Steve Moses has it right for the wrong reasons! In-Home Supportive Services coupled with the Waiver for Personal Care Services allows me to live at home with multiple disabilities. I have over 500 hours of home care. If however, I had to live in a Skilled Nursing Facility it would cost the State of California in excess of four times the amount of money when I can thrive at home with four different home care providers and I working together to make my life as independent as humanly possible and within the limited budget on which I must pay my basic bills. I have a van which I earned through employment prior to and during my disability. I keep it on the road, repaired when necessary–altho, I have to save what little money I can to keep it running. Anyone with a car knows that service is a large part of owning a very old 1996 vehicle.

    I use multiple “community-based” organizations to help me get the necessities such as Meals on Wheels; a meal delivered M-F, on Fridays I get two frozen meals for the weekend. Not resturant quality but it sure fills an empty stomach! A balanced meal with milk and juice or a piece of fruit. The volunteers that bring the lunch are dedicated community members and will stop briefly for a chat if a person lives alone with no one providing much socializing–maybe a 10-15 minutes stay to open food containers. The volunteers, if they see something amis they will report it to the office for follow-up. The Public Libary volunteer brings DVDs and large print books checked out for me. The best EVER people help me in my home and meet most of my needs. Yes, I live on $995 a month. I have worked most of my life, unable to save any more, the tremendous amount of money saved up was spent…GONE with one accident and w/o insurance. I have to pay cash for many of my medical supplies out of pocket or will lose home care hours to pay for them if billed to Medi-Cal, this an option open to me to live independently but also keeps me living from month-to-month on a strict budget. $295 for medical supplies. I pay my share-of-cost for my Medicare medications. Thank goodness for Part D! I an thousands of others like me fear the most is living or warehoused to die in a nursing facility. “We hear people in our community say, “I’d rather be dead than live one day in a nursing facility.

    If you don’t know why, you might want to pay a visit to the nuring facilities that house the very poor. It will not take long for you to see the reasons which will mount up before your very eyes! You life is governed by the facility rules for “residents”. Do not complain, if you do you will get nothing in return. Do not cause any trouble or you will be provided with a subtle no-speak life within the frightening walls–a prison!

    Mr. Moses, you are ignorant to long term care issues. You simply do not have a clue what long term care is and what the options are; what the options mean and why those of us who advocate for ourselves against nursing homes living mean by Independent Living is for everyone at the lowest possible cost to the state. Would you have us shipped out to Mexico sir!? You will one day reach old age and God willing you will experience long term care insurance is not a promise to pay for 365 days of care. Read you policy AND the fine print!

    Reply this comment
  2. Jack Schmitz
    Jack Schmitz 22 June, 2011, 15:36

    I read the fine print in my LTC insurance policy. It will pay for stand-by help with ADL’s and Personal Care provided by an unskilled independent caregiver for 1,825 days. It will even pay in Mexico!

    Reply this comment

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