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The USA Today published an opinion article by Howard Gleckman, a senior research associate at the Urban Institute, on Tuesday discussing the need to include long term care in national health reform. But Mr. Gleckman focused on the cost of skilled nursing care and never mentioned the benefits of assisted living. Rick Grimes submitted a letter to the editor to rectify this shortcoming.

Dear Editor,

We agree with Howard Gleckman (What About Long Term Care? May 26, 2009) that long term care must be part of any comprehensive national health reform. But we encourage policy makers to broaden the definition of long term care beyond skilled nursing homes to include assisted living—the resident-centered alternative to institutional care.  

While skilled nursing is a much needed option for seniors who have become entirely dependent on others for their care, it is a mistake to equate long term care only with nursing homes.  Despite the government’s long term support of nursing homes (as represented by the current Medicare and Medicaid rules), assisted living is quite often the most appropriate, most desirable, and far less costly option for seniors who need some assistance but who don’t need the 24/7 medical care offered by nursing homes.   It embraces an individual’s right to chose where and how she wants to live while providing optimal independence for individual residents, security and quality care, and peace-of-mind to family members.   

When Congress created Medicare and Medicaid in the 1960’s, skilled nursing home care was effectively the only long term care option for seniors. If one couldn’t live at home or move in with a relative, it frequently was the only option.  But with many seniors remaining healthy and active well into their 90’s today, assisted living (average age 86.9 years!) is now far and away the most popular option for those who cannot (or chose not) to live at home but don’t need round-the-clock medical care.   

Yes, lawmakers must consider long term care in health reform but they need to leave their old fashioned definitions of long term care far behind to embrace more contemporary options.  


Richard Grimes
President and CEO
Assisted Living Federation of America (

Tel: 703 894 1805

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