1. _4.1 average_____On a scale of (0)
most disagreement, to (5) neutral, to (10) most agreement, what is
your view on whether more state revenues should be earmarked for long
term care in future years, even if the result is less revenue for
other functions including education?
2. _6.6 average_____On a scale of (0)
most disagreement, to (5) neutral, to (10) most agreement, what is
your view on whether it is possible to hold down growth in long term
care expenses by relying on more in-home care by family members?
3. Any matters missing in this summary that you wish would have been
(see comments below)
Shari Prest (2) (3)
Question 1: Our ability to pay for anything in the future depends on
the education and civic mindedness of our kids. We need more $ for
education and increased educational expenses, spent wisely, and on
known best practices and fewer partisan mandates.
Question 2: Certainly it would reduce costs but it also could restrict
caretaking family members from pursuing their own dreams and
contributing to our society in the ways for which they are best
prepared. Many family caretakers are having to make painful decisions
about whether to put their resources into their parents' welfare,
their children's education and development, or their own security.
None of these scenarios even address the family members' own quality
of life. There is a role for families and society in this dillemma but
I don't think any current models come even close to the ultimate
solution. Perhaps there is a better way to structure senior and/or
long term health communities. Perhaps, like social security, an amount
should be taken out of every income check and put in a fund (private
Question 3: Individuals, like society, should be required to take
responsibility to the greatest level reasonable for possible future
life scenarios. Even when an individual requires long-term care they
need to feel a life purpose. As a society, we have done an egregious
job of providing those opportunities. No one wants to live out their
lives as a liability or burden on either family or society. Meaningful
lives are far more consequential to aging people than the length of
life or where they drive to get their drugs or who writes out the
prescription. Ensuring our most experiences citizens have meaningful
roles as long as possible is also more consequential to our world,
country, communities, and homes than long term care. Yet it is a far
more difficult issue and therefore often ignored or responded to with
clubs, centers, or "hobbies".
David Mooty (7)(3)
Wayne Jennings (9) (4)
Donald H. Anderson (8) (5)
Question 3: As one of the older population I see a need to address
long-term care. Our earnings were made when salaries were much lower
than today's, yet health care is based on today's prices. As a result
many of us can't afford paying for long-term insurance at a rate that
would pay today's costs. Unfortunately, the public will have to bear
the cost or the elderly will have to be "put out to pasture".
Bright Dornblaser (3) (3)
Question 3: More on how to motivate/facilitate the purchase of long
term care insurance by those who can afford to do so, e.g. non
profit/state sponsored long term care insurance plans. More on how to
support the use of non-family care givers.
Bert Press (0) (5)
Bob White (5) (5)
Question 1: Increases for long-term care must be accompanied by the
kinds of changes these insightful folks talked about: community
chronic care rather than just more nursing homes, subsidies or the
equivalent for helping geezers live at home, etc.
Question 2: Neutral on this one as well, only because trends show that
family members are unlikely to be able to give more in-home care...
unless they get some compensation from the state -- which would be a
lot less expensive than nursing homes.
David Dillon (0)(8)
Al Quie (0) (10)
State Rep. Alice Hausman
Did anyone at this meeting mention the Living at Home - Block Nurse
program? It is a community-based structure that is a model for all you
suggest. There are programs all over the state and they run on a shoe
string because they use volunteer resources from the community. Each
year we ask for a pittance of additional funding from the legislature
begin more programs, but we are often unsuccessful. I suggest you have
Marge Jamieson, founder, and the current Director in to talk about
this program. It might also be helpful to have one or two community
organizers attend, one urban and one rural.
Jan Hively (_) (5)
Question 1: There are many more perspectives regarding changing
expectations for aging that affect the state budget besides thinking
about long term care. It's disappointing to see that both the Citizens
League and the Civic Caucus are focusing their studies of aging on
long term care.
Question 2: We cannot rely on more in-home care by family members.
There are fewer family members (30% of boomers don't have children)
and what family members there are are often scattered geographically .
However, changes in building and zoning codes (universal design,
residential/commercial mix, co-housing, etc.) and expanded access to
new technologies such as telemedicine can expand the capacity for
people with disabilities to care for themselves, while community
services to support "aging in place" can be dramatically expanded.
Absolutely, we can hold down the growth in long term care expenses,
but not by family members.
This is really useful -- thank you.
Paul Hauge (5) (10)
Margaret Donahoe (5)(7)
Question 3: Transit services are critical for allowing people to
remain in their own homes while not continuing to drive as driving
skills inevitably decline with age.
Ray Cox (10) (10)
Question 3: a) I believe it is very important for the state to look at
what level they are allowing people to 'pauperize' themselves by
transferring assets to others. At what point should a person with
assets be responsible for their own long term care? b) We need to keep
pushing for tax credits for long term care insurance. I'd like to see
the insurance industry come out with a product that starts out as life
insurance (with some type of cash value) then switches over to long
term care insurance. That way a young person can purchase it when they
need the life insurance protection, and keep funding it as it turns
into long term care insurance.
Bill Hamm (6) (8.5)
At age 56 it isn't looking good at all. As a DAV my health care is the
VA which is about as close to Canadian style single payer as you can
get, (hurry up and wait). As "The New World Order" keeps steeling more
of our freedom the light at the end of the tunnel may begin to look
better all the time in spite of warnings, "Don't go toward the light".
Friends and family have quite asking why I keep trying to make a
difference, they seem to know now that it's an addiction that only a
few of us per thousand share. When you think about the American
Revolution initially only having a 5% support base it makes one wonder
what issue will be the one to motivate even that small a number again.
Question 1: I suspect more money is going to be spent even if we don't
earmark it which I would prefer we didn't. Let's strongly look at ways
to help the families assist the elderly in every way possible to
maintain their assets as long as possible. I strongly suspect that the
family can provide the care needed at far less cost to the state if we
are fair in the way we help them in return. Many issues surrounding
how this can be done have been identified and some direction has been
set, now it needs to be taken to the public and the legislature to be
refined. We need to fully explore financial incentives.
Question 2: Yes, if government doesn't overplay it's hand and make
matters worse. I am not comfortable with Public entities and Health
Care Corporations making these decisions without a dominating elderly
and caregiver constituency overseeing their efforts.
I would like to see this item revisited after next years census info
is in hand.
Charles Lutz (5) (9)
Bill Frenzel (0) (3)
Question 1: No state revenues should be earmarked for anything. How
they should be spent should be a biennial determination of the
Question 2: In-home care by family is the best care. If families are
willing, their care would hold down costs. It is apparent, however,
that families are less and less willing to care for their own.
Marina Lyon (3) (7)
Question 1: We shouldn’t assume that more money is needed. The
speakers indicate more options for care are needed, and most cost less
than what is currently provided.
Question 2: Should be possible to hold down costs if family members
are involved. And family members who are caregivers may need
flexibility to provide the care, but they should not expect to be
paid. Families bonds should be much stronger.
Question 3: The role of the federal government in providing subsidies
for senior housing was not discussed. Capital costs are huge, and
while tax credits play a role, I wonder what the bill adds up to in
this area (total, not just federal construction costs.)
Rick Krueger (5) (5)
Question 2: I fully understand that if the population remains
unchanged, then clearly in-home alternatives are less expensive than
nursing homes. However, based on taking care of both my parents (who
are now deceased) with siblings and succeeding in home health care for
all but about half a year with my dad there are other considerations.
If we would have received tax credits for example, that would have
made things considerably better for us in terms of affording and
providing supplemental assistance. However, if an expanded pool of
people start qualifying for tax credit that previously were ineligible
for support then that my actually increase costs. So in and of itself,
more emphasis on home health care doesn’t necessarily equate to
reducing the overall system costs.
There are no easy answers here, but the analogy might be private
schools. If all students in private schools (approximately 10% of
school aged population) were all of the sudden to get the same student
aid as public school students, the ramifications would be profound.
Either the state budget for k-12 education would soar with the new
influx of eligible students or the average amount of money paid to all
students would significantly drop if the total amount of money
I have never seriously studied the issue of how to fund health care
for the aging population. However, from dealing with my parents my
impression is that a whole lot of health care costs goes towards
activities unrelated to patient care. In nursing homes, I would
venture that well over half the food that is required to be served is
thrown away. I would also bet that nurses actually spend the majority
of their time on paperwork versus patient care. The current system
seems to be set up for an inordinate amount of waste and such an
exorbitant documentation that the patients is left with mediocre care.
There were many times I would have much preferred the care givers
spend time pay less attention to bureaucratic requirements and more
attention to my parents.
Bill Kuisle (1) (7)
Question 3: The services we provide now to the senior population will
not be affordable in the future. We all are going to have to work
longer and retirement will be postponed.
Bob Brown (6) (10)
Question 1: We can’t fall into the trap of a zero sum game – good
planning and public policy should help develop more resources to meet
the many demands on public needs.
Question 2: But the state should give some recognition and support
(possibly tax deductions or credits?) to the family members providing
Question 3: This is another area of public policy in which planning
must be integrated with planning in other areas such as
transportation, economic development, community development and zoning
(to maintain age diverse communities), and education (particularly
community education to provide some training for family and volunteer
I am sorry that I cannot score your questions. I first must know what
the experts suggest with respect to private, home or governmental
solutions for an agreed upon serious problem. I would suggest that
references to what other developed countries have done would be
helpful. Someone pointed out the UK's experience with a savings plan;
this was the only reference and it was not explained. I think knowing
what other countries are doing to ameliorate a growing crisis (do we
enough of crises?) would give us ideas; we need ideas!! and not
necessarily those born in the USA.
Jim Keller (2) (10)
Glenn Dorfman (2) (2)
Question 1: This has been happening in Minnesota for a decade. Growth
in human services has far outstripped k-12, higher education or local
government aid. We cannot say we care about our future and continue to
allow more money to be shifted to the old and the infirm and away from
the young and future!
Question 3: Family member assistance is a pipe dream whose time has
passed because of two wage earners, higher expectations for
accumulating more “stuff”, geographical dispersion, and a societal
unwillingness to sacrifice for others. What I believe might work is
educating the public on the need to set up a long-term care health
care annuity (similar to the 529 Education accounts). These annuities
would be untaxable, period.
Larry Schluter (6) (5)
Question 3: I think as a individual and the state do not want to
address this issue as its a situation we don't like to think about and
for the state it is long term, expensive and complicated. I think long
term care needs to be purchased by more people and greater tax
incentives need to be provided by both state and federal. In the long
term the loss of tax revenue will more than make up for the cost of
providing the care needed for this increasing population.
Marianne Curry (5) (10)
Question 3: Non- government solutions such as tax incentives (like the
tax deduction for dependent children) for in-home care provided by
families should be part of the discussion. We cannot afford to build
more bureaucratic empires in health care.
Ray Ayotte (7) (10)
Carolyn Ring (5) (9)
Question 2: Families have given up their responsibility to the
Kent Eklund (3) (8)
Question 3: Whether one agrees or disagrees with the two propositions,
there is a tremendous task of building consensus before meaningful
policy directions can be set.
Also, re long term care insurance: Your report arrived on the same day
I read an email //http:forums.e-democracy.org/groups/us/messages/topic/7KYGHiUjKAwvHnzwUHfHMu
about sharply rising premiums for long-term care, and received my own
notice from Prudential that my and my wife's premiums were going up
28% on the next anniversary. Reminds me of adjustable rate home
mortgages, and look where they have gotten us.
Scott Halstead (_) (8)
Question 3: We need to address the how we reduce the chronic care. As
we have changed our work environment, individuals experience less use
of their bodies. We also have changed our diet to include less healthy
ingredients. As a result, approximately 2/3rds of the adults are
overweight or obese. The risk of getting chronic diseases increases
greatly which results in a reduced quality of life, a shorter life,
increased use of high cost medical care, higher needs for long term
care and the assistance of family members.
We need to address these issues. All group policies including Medicare
should charge a surcharge for preventable lifestyles that generally
result in higher use of medical services for chronic diseases. Add a
dedicated sales tax at the State and Federal level on food that is
unhealthy. Improve preventive medicine. Promote healthy living.
We need to change the law on transferring assets so we don't burden
Medicaid. We should develop a long term care IRA that can be
transferred to family members if not utilized and must be exhausted
before Medicaid is utilized.
Shirley Heaton (0) (0)
Question 1: The time has come for us to stop turning to government for
funds. I hate like heck to offer this idea but we may as well turn to
the 'money pots' -- yes gambling sources. And how about the 'deep
pocketers' who have found ways to illegally duck their tax liability
responsibilities? It occurs to me that perhaps we could discourage the
latter by providing tax exempt incentives to such business folk. For
example, the IRS might take a harder look at its tax-exempt structure
for non- profit organizations, making them more palatable for those
Question 2: Remember, it's only those who remain in the area who are
'stuck' with the responsibility. Other family members beyond the
jurisdiction of kinship are unreliable. There is a segment of our
population which has not really been tapped -- the 'unwanteds' who are
forced to live in ghettos but who want to be useful citizens if given
the opportunity. Surely there are sociologists who have ideas on
overcoming our persistence in perpetuating the system of ignoring or
band-aiding this element.
Question 3: I just think you should approach this matter with
Sociologists and others in related fields. This is a matter which
takes more than money.
Terry Stone (5) (8)
Question 3: This is an excellent treatment of shifting demographics;
their implications to long term care requirements, to governance and
possible solutions. The discussion would benefit from a conservative
perspective. Since I’m unencumbered by any expertise in this area,
I’ll do my best.
We might back up a bit and ask, “Is care of the elderly an appropriate
function of government and, if so, which level of government?” The
next question seems to be, “Even if this is a constitutional and
legitimate function of government, is it a function that government
can perform effectively and efficiently?”
Free bonus question #1. Is long-term elderly care something that isn’t
a legitimate function of any level of government, by any stretch of
the imagination, but is being pushed upon government by a societal
decay of family structure?
Free bonus question #2. Society fights tenaciously to keep local
control over its children’s education because it values its children
too much to surrender them to governmental control. Why is society so
eager to invest in estate planning, family trusts and reverse
mortgages to assure that the elderly end up penniless and in the
control of government?
The correct time to transform Minnesota for 2010 was 1950 when it was
clear to demographers what was in store for 2010. Both individuals and
society made certain trade-offs. We, individually and collectively, as
both a society and as a government, chose a culture of consumerism and
excess over saving, prudence and frugality. We have a culture with
spending priority disorder (SPD) that manifests itself at all levels
of American government.
Our lack of preparedness for late life expenses is a deducible
extension of the logical consequences of a long series of bad personal
and collective choices.
We find that the metrics of “standard of living” were too heavily
weighted by TV sets and other appliances per household; and too
lightly weighted on financial sustainability and saving rate.
Since my premise is that the eldercare situation is commonly a direct
result of a series of poor lifestyle choices, it follows that those
very lifestyle choices are an early predictor of health and retirement
insolvency. If government has a useful role in this subject, it may
well be early detection and intervention. Those who will scream
loudest against early government intervention will be those who are
currently screaming loudest for government intervention in long term
While Transform 2010 has its warm fuzzy value, only government
bureaucracy would come up with these ideas in the complete absence of
recognizing lifestyle-spending choices as a fundamental cause of the
Without addressing the underlying problem of spending wealth, in lieu
of building wealth, we can commission the same study again in 2045;
we’ll call it Transform 2050.