Marilee Driscoll: Long-term care and the measure of greatness

Marilee Driscoll

This sentiment was in the last speech of Hubert H. Humphrey. Similar words have been spoken by others, including Mahatma Ghandi, who said “A nation’s greatness is measured by how it treats its weakest members.”

When we discuss how the American government treats the elderly, the evidence is mixed. Let’s take a look at what the current presidential candidates are saying about long-term care.

The next 60 words are what the Obama campaign site says about long-term care: 

Strengthen Long-Term Care Options: As president, Obama will work to give seniors choices about their care, consistent with their needs, and not biased towards institutional care. He will work to reform the financing of long-term care to protect seniors and families. He will work to improve the quality of elder care, including by training more nurses and health care workers.

What do I think? Well, what’s not to love? In terms of critique, where do I start? Obama’s statement acknowledges the fact that the current financing system (read: Medicaid) is biased towards institutional care. He’s right. We all know that non-institutional, home-based, long-term care is what people prefer.

Back in the early 1980’s, Congressman Claude Pepper acknowledged the “woodwork effect”; if the government Medicaid program started paying for long-term care where individuals wanted it (NOT in a nursing home), applicants for this taxpayer-funded program would “come out of the woodwork.” So, if the government starts funding more home-based and non-nursing home care, how will we pay for increased demand for these services?

As for the last sentence, “working to improve the quality of elder care…training more nurses and health care workers.” Nothing there to argue with. However, the reality is that LTC workers are among the lowest-paid workers, and any real solution will involve raising this pay – and our costs. OK.

John McCain Will Develop A Strategy For Meeting The Challenge Of A Population Needing Greater Long-Term Care. There have been a variety of state-based experiments such as Cash and Counseling or The Program of All-Inclusive Care for the Elderly (PACE) that are pioneering approaches for delivering care to people in a home setting. Seniors are given a monthly stipend which they can use to hire workers and purchase care-related services and goods. They can get help managing their care by designating representatives, such as relatives or friends, to help make decisions. It also offers counseling and bookkeeping services to assist consumers in handling their programmatic responsibilities.

Huh? Upon further reflection, the first sentence says it all. “John McCain Will Develop A Strategy…” – as in the future. The rest of the paragraph is a re-hash of a “variety of state-based experiments,” primarily PACE. And, like apple pie and babies, what’s not to love about PACE?   How can you not like money given to seniors to pay for care in their own home (unless it’s your money)? Only 15 states have chosen to implement PACE programs, which is curious, since they have been available since the early 1980s. PACE is funded by both Medicare and Medicaid, which means that recipients must be both financially and medically needy. PACE may be a viable option for the poor, but the big question is how to fund LTC for the middle-class and upper-middle-class. So, it seems that we’ll have to wait to find out exactly what, if any, long-term care reforms these candidates will champion.  

Note: October is Long-Term Care Planning Month, which I founded in 2001. This is a great time to figure out: “What’s your long-term care plan?” Because, by now, you know, it’s up to you to have a plan, to fund a plan, and to communicate your plan. More at 

Plymouth resident Marilee Kern Driscoll is a professional speaker and author of “The Complete Idiot’s Guide to Long-term Care Planning.” She has been quoted in hundreds of newspapers and magazines, including The Wall Street Journal and Kiplinger’s Personal Finance, and has been interviewed on the CBS Early Show. She encourages you to ask your questions, subscribe to her free newsletter and final local help with this topic at