Remarks as Prepared for 24th National Home and Community Based Services Conference

Thanks to Josefina Carbonell, or as she is sometimes known, Senora Medicare, for the introduction.

I recently learned that Josefina, who our boss, Secretary Mike Leavitt, sometimes refers to as a “rock star” is an expert salsa dancer.

Perhaps she will demonstrate some of her moves for all of us later?

While doing a Medicare event with President Bush, Josefina had the opportunity to fly back to DC on Air Force One with him.  During the flight, she told him about her son, Dr. Alfredo Carbonell, who is a surgeon.

Josefina told President Bush how thrilled he would be to learn she had the opportunity to fly on Air Force One.  The President advised -- even encouraged her -- to give him a call right there and then.

At first, she was reluctant, but the President continued to urge her and reassured her that it would be fine.  So, she gave the operator her son's cell phone number.

The Air Force One operator placed the call and when he answered said, "Dr. Carbonell, this is Air Force One. I have a call for you, please hold while I connect you." 

He thought that some prankster had gotten his cell phone number and said, "How did you get my number?" and proceeded to hang up! 

The operator then told Josefina that she was unable to connect the call because her son had hung the phone up.   They placed the call again, but this time, Josefina remained on the line. 

When her son saw the unknown caller id again he answered ready to let this prankster have it.  Josefina had to quickly say, "Alfie, it IS me, and I AM calling from Air Force One with President Bush!!!" 

But the fact she was on Air Force One should not have been so unbelievable because Josefina and her staff at AoA are doing great work and play a key part in President Bush’s vision for health care.

That vision is value driven health care. Give consumers the tools they need to make educated health care decisions that work for them; the future of health care is personalized.

And because of innovations in science and technology, the future will see lives extended, diseases cured, and more and more Americans with access to health care.

But right now we face several challenges, especially in the area of long-term care: baby boomers are aging; America’s older population is getting larger.

Every five minutes in the United States, 23 adults are turning 65 – and by 2030 that number will double. Within 10 years, almost 50 million Americans will be over 65 and for the first time in our history, the elderly will outnumber children under the age of 5.

16 million of these older Americans live with chronic conditions that impair their ability to  carry out the activities of daily life, such as grocery shopping, cleaning house, preparing meals or even getting out of bed and bathing (or if you’re Josefina – salsa dancing.)

Because of these conditions, 5 million seniors depend on living assistance from others. Of these 5 million, 80 percent rely on their families for care and assistance.

It makes perfect sense that we want to be responsible for the care of the people we love so much. But there often comes a time when a family is no longer capable of meeting the needs of their loved ones.

Unfortunately, if and when that does time come, too many Americans find a long-term health care system that is fragmented, confusing and centered on expensive institutional care.

The numbers tell the story: Americans currently spend more than $200 billion a year on long-term care; 60 percent of these dollars go to nursing homes. 30 states are spending 75 percent of their medical long-term care budgets on nursing home care and a dozen of these states are spending more than 85 percent on this form of care.

An individual over age 65 can expect to spend nearly $50,000 on their long-term care, and 16% can expect to spend more than $100,000.

When people look to Medicare to help with long-term care they are often overwhelmed by a confusing maze of agencies and bureaucratic requirements. This system is too expensive, too complicated and too cumbersome.

To meet this challenge, HHS has advanced the New Freedom Initiative (NFI.) This plan calls for a system of care that empowers people to make informed decisions and places emphasis on the care they receive in their own homes and communities.

So far, the New Freedom Initiative has:

• Doubled funding for home and community-based care under Medicaid  
• Held the growth of nursing home spending to just over 3 percent.
• Invested $300 million in grants to states to help develop more efficient and affordable long term care systems
• Partnered with 19 states on public education campaigns to raise awareness of the importance of planning ahead for long-term care
• Launched a long-term care clearing house Web site – www.longtermcare.gov
• Expanded the state Long-Term Care Partnership Program to help individuals take more responsibility in planning and financing their future long-term needs

These are important accomplishments. I’m proud of Josefina’s leadership on this issue. She has paved the way in modernizing long-term care by building partnerships with other federal agencies and within the private sector to create:

• Ageing and disability resource centers
• Evidence-based prevention programs
• Nursing home diversion programs

Since 2003 AoA has used $80 million in funding to leverage assistance from sources such as CMS, CDC, AHRQ, state and local governments and private foundations to raise an additional $100 million to support and reproduce these programs around the country.

Because of this, we now have:

• 175 ageing and disability resource center pilot projects operating across 47 states reaching over 1.3 million consumers per year
• 587 evidence-based prevention pilots across 23 states
• 91 nursing home diversion pilot sites

Every dollar we and our partners invest in these programs will generate more than $1 in federal savings to Medicare and Medicaid.

I’m happy to tell you that we are awarding an additional $36 million in AoA funding to 28 states to help reproduce these programs.

And today, Josefina has helped us create an important partnership with the Department of Veterans Affairs, which will use our Aging Services Network to provide home and community based services to disabled veterans.

These are all remarkable accomplishments that will help us reach our goal of a long-term health care system that is driven by consumers.

And this fits into the Bush administration’s broader vision for health care.

By giving all Americans, including our veterans, the power to choose the services they want and make informed decisions, we can overcome the obstacles that stand in the way of creating an affordable and accessible health care system.

And in the realm of long-term care, we will give so many older Americans and their families exactly what they wish for: the option to live their lives with dignity, near their loved ones, in the comfort of their own homes and communities.

This is the way it should be.

It’s the right way: it’s innovative, it’s economical and above all, it’s humane.

And it’s what millions of American families want.