The Questions:

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 addressed?
(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 or public).

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 to
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.

Mark Ritchie
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. Take care.

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 legislative process.

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 remained constant.

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 the care.

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 caregivers.)

Jim Weaver
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 government.

Kent Eklund (3) (8)

David Hutcheson
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 'deep pocketers'.

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 elder healthcare.
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 issue.
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.