The following article was reprinted from Business First of Louisville, February 16, 2007 edition:

The Home Care & Hospice industry Strategic Planning Congress, a working strategic planning session for the future of home care and hospice in this country, concluded recently in Scottsdale. Having been a direct provider in the home care industry from 1981 to 1998, and now actively involved in communications for that industry, the information for long term care in America should interest us all.

Since Ron Crouch, MSSW, MBA, Director of the Kentucky State Data Center started alerting Kentuckians about the effects of an aging society several decades ago, and how Kentucky is ahead of the curve as to what America will look like as its citizens age, not much has changed in how we are approaching this phenomena.

Americans are aging and with aging come more demanding care needs. The National Institute on Aging predicts that the number of people at least 65 years old will double in the next 25 years to some 72 million people. Today, the fastest growing age group in the U.S. is what demographers call the "oldest old" – people 85 and older – and their numbers are also expected to double in the next 25 years, to about 10 million. The U.S. Census Bureau says that about 70,000 centenarians now live in the U.S., and predicts that by 2040 there will be 580,000. To sum it up, a recent article in the New York Times (Dec 30, 2006) stated, “...never has old age lasted so long or been so costly...”

At the National Association of Homecare and Hospice Congress, industry experts reported on what they felt was a 60,000 foot view of areas on which consumers needed to be aware and/or Congress should take issue. Bob Beckel, CNN/USA Today Political Commentator strongly feels that Social Security is on the brink of disaster. Scott Frey, Senior Advisor to the President for Policy and Coordination, National Committee to Preserve Social Security and Medicare reported that health care reform should be the main issue with which we Americans are concerned, and that it is the unfunded and off budget items that are causing problems, not entitlements. He reported that Social Security is in fine shape.

Rhonda Richards, Senior Legislative Representative, Federal Health and Long Term Care Team, AARP Government Relations and Advocacy gave a presentation that focused on AARP’s 38 million members and that organization’s push for drug pricing negotiations, and changing asset tests to get the low income elderly more discounts on drugs. The AARP, the Business Roundtable and the SEIU (unlikely partners) have joined together and have a Web site www.DividedWeFail.org to find common ground and to work towards issues on which all three can agree.

Andrew Imparato, President and CEO, American Association of People with Disabilities focused on the latest government pilot programs that are founded on the principal of “money follows the person” to try and get in-home care as an option more often than the more expensive current options that include various forms of institutionalization. However, this stand assumes that the consumer will have the wherewithal to hire, supervise and monitor in-home workers.

One other little known factor is a case that is currently before the Supreme Court that will affect long term care in America greatly. Many in-home caregivers gladly work more than 40 hours a week without overtime pay because of the federal government’s definition of "companionship services” and the Federal Fair Labor Standards Act which currently allows a companion to work in a caregiving situation without overtime pay. Many persons who want to remain at home as they age are in a situation requiring care for more than 40 hours a week. At issue is the continuity of care from one caregiver, plus the ability for a lower wage worker to work only one job and not have to work two jobs to make more money. Many lower waged workers oftentimes work two jobs to make ends meet.

There is already a shortage of suitable workers for in-home care. If the Supreme Court upholds the lower court decision, home care providers will either face increased wage costs or be forced to limit the working hours of staff to avoid overtime. Where working hours are limited, the home care providers will need to engage in increased hiring to offset the lost availability of existing workers to meet service hours. The only other option is to raise charges to clients to cover new overtime costs. The actual hearing before the Supreme Court could be in the third or fourth week of April.  Tracking developments of the case requires only Internet access; go to www.supremecourtus.gov/docket/06-593.htm.

Basically the results of the strategic planning call for more education for consumers, providers and the industry about long term care options and how we as a nation really need to create a strategy for a less fragmented system that will provide adequate care for us all as we age. This includes finding, hiring and training workers, expanding coverage of payment mechanisms to cover more home care options, and creating continuums of care that all work together.

Merrily Orsini, MSSW, is a home care industry veteran who is Managing Director of corecubed, an integrated marketing communications company located in Louisville, KY.