Week before last, my parents moved out of their home of almost 40 years and into a nearby high-rise tower that offers the services of a continuing care retirement community. While they will be using only minimal supportive services for now (dinner in the dining room and housekeeping), I think their decision shows admirable foresight and thoughtful planning. The old house with its many stairs and automobile-only access was becoming a precarious match for their changing capabilities. Getting out a bit early may be slightly awkward (they will be 10 years younger than most of their neighbors) but it feels like the right time.

Not only is their new home large (more square feet than my row house) and lovely (with a view of Oakland's Lake Merritt), but it also offers additional services if they should be desired and needed - on an a la carte, buy what you need, basis. These include health care support from an on-site nurse, additional meals, cleaning/laundry, and personal care assistance, should they need them. In many ways, this is the ideal of long-term care — the ability to age in place with only as many services as you need — maintaining autonomy and independence. But the prices for these services are very sobering and clearly out of reach for the majority of Americans. As I've said before, if you aren't frightened about long-term care — getting access to the services you want AND being able to pay for them — you just don't understand the situation.

So while my parents have launched into a new stage of their lives, what are the chances for the majority of older Americans? CLASS (Community Living Assistance Services and Supports), the new long-term care insurance program passed as Title VIII of the Patient Protection and Affordable Care Act, was intended to be part of the answer to the dual problems of access to services people actually want (i.e., NOT nursing homes) and some way to pay for them. Unfortunately, its ability to start this year no later than Federal fiscal year 2012 is still uncertain.

CLASS was designed to be a voluntary, premium supported, government run insurance program that would provide a guaranteed cash benefit to be spent by consumers on a broad range of services intended to keep the person in the community as much as possible. By law, CLASS is not allowed to tap into general revenues, but is to be entirely supported by the contributions of those who choose to participate. If you think about it, you will realize setting up such a program so that it will launch in an actuarially sound fashion, while keeping premiums as low as possible, so as to attract the most participants, so as to keep premiums low, etc. is quite a trick. The degree of difficulty is clear when you recall that such industry leaders as MetLife (in the last year) and TIAA-CREF (several years ago) abandoned the long-term care insurance market as too small and too difficult.

The current consensus is that the CLASS program as laid out in the law is a non-starter. Given the generosity of the benefit and the low barriers to eligibility it would have to be priced so high as to start the fatal downward spiral of adverse selection where only those who strongly suspect that they will be using the benefit would ever enroll, driving price up . . . and up . . . and up and enrollment down . . . and down . . . and down.

Politicians in Washington are vigorously debating whether the secretary of HHS has the authority to modify the program to give it a chance of successful launch or if those powers are reserved to Congress. As neither a lawyer nor a politician, I don't have a useful view on that issue. However, just as important as the political are the practical questions of just how to design benefits, define eligibility, and set premiums to maximize the possibility of success. In fact, if we can answer the practical questions, some of the controversy may melt away (although surely not all).

This is where the efforts of The SCAN Foundation continue to be so valuable. Today they released 16 Technical Assistance Briefs covering a wide range of implementation issues for the CLASS program. These range from an analysis of the benefits of redesign and assistive technology in the home by a team from Johns Hopkins, including Hartford Post-Doctoral Fagin Fellow Sarah Szanton, to extensive analysis of the results of the consumer-directed Cash and Counseling program at Boston College by geriatric social work leader Kevin Mahoney, to an analysis of the direct care workforce available for personal care services by PHI's Director of Policy Research, Dorie Seavey. Thanks to SCAN, the debate on CLASS is now informed by the best experts in the field, each focused on solutions to critical program design questions. When CLASS finally becomes a reality, it will owe a great debt to the leadership of The SCAN Foundation.