Some foundations fall prey to exaggerated fears of being accused of lobbying and stay as far away from lawmakers in Washington, DC, as possible. However, The SCAN Foundation is one organization that knows its rights, knows the law, and knows and cares about the issues of aging--and besides, when you are invited to speak at a Senate committee hearing, you are pretty safe anyway.

So congratulations to its President and CEO, Dr. Bruce Chernof, on his testimony last week to U.S. Senate Special Committee on Aging's hearing on "The Future of Long-Term Care: Saving Money by Serving Seniors."

Despite the debacle of the halted implementation of the CLASS Act--the provision of the ACA that tried to create a new voluntary long-term care benefit for Americans--and the subsequent slew of insurance companies that have left the long-term care market, the need for long-term care hasn't gone away.

As Dr. Chernof testified, our best estimate is that 70% of Americans "who reach the age of 65 will need some form of LTSS [i.e., long-term services and supports] in their lives for an average of three years."

And, because we are living longer and more of us will survive various acute ills that in former days might have killed us, more of us will live long enough to need long-term services and supports in the future. Chernof continued:

The percentage of the “oldest old” or those age 85 and older is expected to increase by more than 25 percent by 2030, and it is among this population that the LTSS need is most substantial. Approximately 30 percent of those age 85 and older have moderate to severe LTSS needs, three times the proportion among those 75 to 84 years old.

Unfortunately, because retirement income is so precarious and long-term care so expensive, very few people have the financial means to pay very long for their own care. This has made Medicaid the defacto long-term care insurer in the US, paying for 43 percent of all long-term care expenses.

Dr. Chernof shared some good news as well: the ACA still has many provisions that can help improve the quality and affordability of long-term care, ranging from incentives to get people out of institutional care and back into their homes, to cash and counseling consumer choice approaches, to the new office of the duals that is trying to get Medicare and Medicaid to coordinate better.

Across all of these efforts, The SCAN Foundation has identified five core elements or “pillars” of system transformation that are building blocks to achieving a more person-centered system. These five pillars of LTSS system transformation are:

• Administrative reorganization - reducing the burden of confusing and overlapping responsible agencies and programs

• Flexible accounting practices - letting the money go where it is needed

• Uniform assessment - using a single assessment of beneficiary status and eligibility to ensure fair access to programs and benefits

• Integrated information systems - sharing information across program and provider boundaries

• Quality measurement and quality assurance - using information and measures to make sure that programs are meeting beneficiaries' needs and personal goals.

I think these are not only good principles for long-term care reform, but excellent guides for health care in general. All of our silos and independent satrapies in care--whether nursing homes, doctor's offices, and even community agencies--fragment care, eventually raise costs, and by failing to work together create gaps in care into which people fall all too often. Let’s use these pillars of transformation to do better.