Bottom line: You won’t get quality care in America’s nursing homes — even if you mount armed guards in every one of them — as long as nurse aides can make more money working with fresh vegetables and soda pop at the Taco Bell than they can make for working in blood and feces at the nursing home.

America’s messed-up long-term care service delivery and financing system is self-inflicted by perversely counterproductive public policy. The good news is we can fix it over night. Just stop doing what we’ve always done and we’ll get a different result. Albert Einstein called that the definition of sanity.

To wit: Stop giving away most home care and nursing-home care through inadequate public programs. Make middle-class and affluent people pay their own way, either up front or later through estate recovery. Stop using Medicaid as free inheritance insurance for the baby-boom generation. Use the savings to pay for tax incentives for LTC insurance, LTC education programs and to promote the use of home equity to fund LTC.

Plan early. Save. Invest. Insure.

Richard Schafer

Minneapolis