1. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services Long Term Care What You Should Know About a Broken System and Why Fixing It Matters to You

2. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services What’s PANPHA? PANPHA is a statewide organization representing more than 350 nonprofit providers of long-term and continuing care

3. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services What is long-term care? More than traditional notion of ‘nursing home’ Continuum also includes adult day care, housing with supportive services; assisted living; continuing care retirement communities (CCRC’s); home and community- based services

4. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services Today’s Reality… Largest generation of seniors ever will be requiring - and demanding -choices in long-term care  People living longer with assistance of expensive medical care  Want to “age in place” in the least restrictive setting they can call home

5. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services The Reality… The current system is simply not sustainable  Critical shortage of workers  Regulatory system that gets in the way  Insufficient financial resources

6. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services Topics of Discussion Money Who will take care of us… even if we can figure out how to pay for it? Regulatory system gets in the way… and actually make things worse

7. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services Money Most people ill- informed or unaware of how long-term care is paid for Baby boomers who have been financially secure for years may find themselves below the poverty line in months

8. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services Money… “Even people who think they have a good sense of what the costs and payment options are often get it wrong” – AARP  More than half mistakenly think Medicare covers nursing home stays; 4 in 10 think it pays for assisted living.  Only 15% estimated the cost of nursing home care within plus or minus 20% of the national average ($4,654/month); 25% estimated assisted living costs within +/- 20%  Medicaid requires spending down assets to poverty level; Many middle class seniors have exhausted virtually all life savings and assets to pay for care, most within one year of being admitted to a nursing home

9. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services Who’s Going to Take Care of Us, Anyway? PA, along with rest of nation, is experiencing a severe shortage of health care workers Long-Term Care hardest hit of all health care settings  Financial, workplace and regulatory constraints not found in other health care settings  Regulatory system contributes to “downward spiral”

10. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services Who’s Going to Take Care of Us, Anyway Unless more people begin to enter the profession, the situation will become worse  High turnover rates and replacement costs  Recruitment challenges (work is difficult as well as physically and emotionally draining)  Demographic mismatch between growing need and lessening availability  Training regulations and enforcement  Society’s perceptions of field  Regulatory and reimbursement policies

11. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services A Counterproductive Regulatory System Current system is highly fragmented and unnecessarily complex, reflecting piecemeal development of overlapping federal and state structures  Duplication of effort by different agencies  Increased costs  Conflict/confusion between different regulators

12. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services A Counterproductive Regulatory System “Cookie-cutter” approach to nursing home inspection does not reward good-quality care nor deal forcefully enough with poor-quality care  Regulators/surveyors have little scope to use discretion and judgment in applying rigidly-detailed minutiae  Difference in amount of potato chips led to deficiency on “inadequate nutrition” grounds  Actually forbidden to offer advice or technical assistance Compliance Doesn’t Equal Quality

13. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services A Counterproductive Regulatory System “Gotcha” mentality drives good, caring people out of profession already faced with staffing crisis Inflexible, punitive environment is frustrating, overwhelming, and detracts from resident care System “devolved” to finding deficiencies; has become end in itself instead of measuring real goal of quality of care and quality of life

14. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services A Counterproductive Regulatory System Downward spiral  Cannot find staff  Cannot innovate or improve when straight- jacketed by regulatory system  High turnover rates and replacement costs  Morale and “stigma” issues from punitive regulatory system and public misperceptions exacerbate staffing crisis

15. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services Realities Long term care is a predictable need for most of us One in five will need services at some time Most do not plan for it Current system is unsustainable

16. PANPHA -- An Association Of Pennsylvania Nonprofit Senior Services PANPHA’s Call to Action Need to make long term care a high-priority public issue, as important as social security and prescription drugs Please join us in the discussion and debate on these issues Good news – there’s still time Bad news – there isn’t much