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November 6, 2006
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Out of the Shadows
Brown Issues Report to National Commission for Long-Term Care

Brown University’s Vincent Mor and Edward Alan Miller have issued a report for the National Commission for Quality Long-Term Care outlining six key areas of concern as “the long-term care system in the United States is threatening to collapse under the massive weight of the aging Baby Boom generation.” The commission, co-chaired by former Sen. Bob Kerry and former House Speaker Newt Gingrich, was established in 2004 to evaluate the country’s quality of long-term care and to make recommendations about national efforts for sustainable improvement.

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PROVIDENCE, R.I. —Two Brown University professors have issued a report to the National Commission for Quality Long-Term Care, describing the current state of long-term care in the United States and outlining six key “areas of concern.” Out of the Shadows: Envisioning a Brighter Future for Long-Term Care in America was authored by Vincent Mor, chair of the Department of Community Health, and Edward Alan Miller, assistant professor of public policy, political science and community health. Both Mor and Miller are also investigators at the Center for Gerontology and Health Care Research at Brown. They began the report when Mor was serving as executive director of the Commission in August 2005.

“Although the United States is aging rapidly, we still have some time before the real tidal wave of the aged population is felt,” Mor said. “But if we do not begin the process of change now for this increased demand for services, it is not clear how we will manage. It will take time to plan and then implement financing and delivery systems that meet the needs of the coming elder revolution. Reform is necessary not only for the sake of future generations of long-term care recipients, but also for the sake of those thousands of individuals receiving inadequate care in the current environment.”

Out of the Shadows is the product of an in-depth examination of the literature, statistical analysis of data, and testimony provided to the commission by outside parties. It is also informed by interviews conducted with commissioners, academics, government officials and industry experts. The purpose of the 100-page document is to “inform the work of the National Commission for Quality Long-Term Care as it heightens awareness and formulates policy solutions to the long-term care conundrum facing the nation.”

“Long-term care consists of many different services and service locations. There is also a broad range of interested stakeholders, not least of which include providers, government, advocates, families, and, of course, service recipients themselves,” Miller said. “But despite widespread concern about the quality of long-term care, we have yet to reach a national consensus about the way in which long-term care should be delivered and financed.”

In the report, Miller and Mor examine six “areas of concern” that must be addressed to create a better system:

  • prioritizing long-term care financing;
  • empowering individuals and families;
  • promoting physical and organizational change;
  • investing in the long-term care workforce;
  • modernizing regulatory controls and incentives;
  • leveraging health information technology.

“To create a fair, comprehensive, affordable and eficient long-term care system, requires a multi-dimensional strategy that addresses different aspects of the problem,” Miller explained. “Unless we engage in a national debate about the six areas of concern outlined in this report, we will continue to find it difficult to develop a strategy to address both current and future need.”

The report has been submitted to all commissioners, including Kerrey and Gingrich, Gov. Haley Barbour of Mississippi, Gov. Phil Bredesen of Tennessee, Sen. Gordon Smith of Oregon, Rep. Earl Pomeroy of North Dakota, and Rep. Nancy Johnson of Connecticut. Commissioner Monsignor Charles J. Fahey called the report “remarkable.”

“I am unaware of anything comparable,” Fahey said. “It is comprehensive, factual and well-written with appropriate commentary. I hope it will inform Phase II of the Commission’s work, since it offers a great starting point. ... It will be widely read and serve as a basis for many better informed conversations.”

Out of the Shadows: Envisioning a Brighter Future for Long-Term Care in America is available for download from