The Pepper Commission on Long-Term Health Care

Article excerpt

The Pepper Commission Report will be available from the U.S. Government Printing Office, Superintendent of Documents, Washington, D.C. 20401, (202) 783-3238 and at some public libraries. Readers can also contact The Pepper Commission (140 Cannon House Building, Washington, D.C. 20515, (202) 225-9950; Fax (202) 225-6653) for more information.

The U.S. Bipartisan Commission on Comprehensive Health Care, named in honor of the late Rep. Claude Pepper of Florida and headed by Senator John D. Rockefeller IV (West Virginia), issued its recommendations for solutions to our nation's health care crisis in March. The complete report is expected to be released after Labor Day.

Word from Washington, a publication of United Cerebral Palsy Association's Governmental Affairs Office, summarized the recommendations in its April/May issue noting: "Recommendations are based on their decision to structure a health care program built on the current health care system instead of replacing what is currently in place... for all employment-based health insurance. No pre-existing condition exclusions; no denial of coverage for any individuals in the group."

Word from Washington "commends the Commission for proposing a comprehensive solution to the nation's health care crisis that extends beyond the piecemeal approach that has been the distressing trend in Congress...

[They] fail to address the numb problem faced by the majority of families with disabilities and chronic conditions that of adequacy of coverage...

Exclusion of physical, speech and occupational therapy, durable medical equipment, assistive devices, personal assistance services, and disposable medical supplies from the definition of basic health care would mean continued high personal expense or reliance on public assistance and/ or institutional care. The excluded services are essential..."

The following material on long-term care is excerpted from the Pepper Commission Report.

WHAT IS LONG-TERM CARE? "`Long-term care' refers to a wide array of medical and personal services needed by individuals who have lost some capacity for self-care because of a chronic illness or condition. These services range from skilled and therapeutic care for the treatment and management of chronic conditions to assistance with basic activities and routines of daily living, such as bathing, dressing, meal preparation and housekeeping. Services can be provided in a variety of settings...

The need for long-term care is usually measured by an individual's incapacity to manage tasks of daily living. These include basic human functions which people do habitually and universally (called activities of daily living, or ADL's), such as eating, getting in or out of bed, using the toilet, bathing and dressing. They also include activities necessary to remain independent (known as instrumental activities of daily living, or IADL's), which include housekeeping, meal preparation, grocery shopping, financial management and taking medication. Limitations in ADL's and IADL's are particularly useful measures of the need for long-term care because they are not tied to specific diagnoses and are good predictors of service needs..."

CHRONICALLY DISABLED CHILDREN.

"Because ADL and IADL limitations are not considered appropriate measures of disability for young children, it is difficult to draw comparable estimates of the need for long-term care for this population. However, as many as one million children may suffer from chronic illnesses which necessitate long-term care. Only a fraction of these children - 174,000 - need assistance with one or more ADL'S; 31,000 require help with two or more ADL'S.

Most disabled children need long-term care that requires low technology. However, the Office of Technology Assessment (1987) recently estimated that an important subset of chronically disabled children depend on life-sustaining medical technology. …