Comment on Donald L. Redfoot's “Long‐term care reform and the role of housing finance”

Abstract

At this writing, the Clinton administration’s proposal for reforming the nation’s health care system has just been released. The proposal includes an optional state-federal program that provides some coverage for long-term care, including home and community-based care for disabled persons. But there is no mention of housing. This iteration in the development of longterm care policy is only the latest in a long history of academic studies of the long-term care system and congressional proposals to reform it. Housing has essentially always been excluded. One must recognize this history of neglect to fully appreciate the significance of Don Redfoot’s article, “Long-Term Care Reform and the Role of Housing Finance.” The article joins what is unfortunately only a handful of writings that have addressed the link between housing and broader social welfare issues—in this case, long-term care (e.g., Cohen 1969; Newman 1990; Newman and Schnare 1992; Noelker 1982; Sussman 1979). Redfoot’s effort and publication of his article in Housing Policy Debate certainly increase the odds that at least the housing sector may begin to pay serious attention to the need to conceptualize the role of housing in long-term care. For this alone, Don Redfoot and Fannie Mae deserve much credit. Redfoot reviews a litany of ills associated with the current system of long-term care and, particularly, nursing homes: high costs that have grown faster than the general inflation rate; inappropriate placement in nursing homes of many elderly who do not require the level or intensity of services provided; the requirement that elderly persons pauperize themselves to qualify for Medicaid coverage of nursing home costs; and discrimination against nursing home applicants whose disability levels generate unacceptable cost-reimbursement ratios. His preferred solution to these problems is universal coverage for long-term care services—a much more extensive program than the optional capped block grant for home and community-based