the mortar. -- bricks and the mortar. we visited different nursing homes. i talked to the nurse, i would like to see your vending area. we did this in 12 areas. the coax and the diet sodas at work in that machine -- cokes and the diet sodas in that machine were up $1.50 per can. that was more than the allowance is that people had. .

they took a snapshot in time. they scored it. they had different bail be different variables the book that. to recount on that? it is a snapshot in time. -- do we count on that? it is a snapshot in time. the administrator of it can manipulate the triangle said

that it works well to maintain solvency and kick a respectable benefit to people. i believe $75 a day is a respectable benefit. it can never be less than $50 a day. the administration needs to come back with a scale. although you see this is what it is, it is not really the case. you see a reflection of the snapshot in time they took. that is what we have to work with. there will be range according to what the functional limitation is and how the model is constructed. the next policy objectives we had was about providing services. that was a big piece. one of the big choices that we had in the development of this

bill was family caregivers. we were trying to determine if family members could be reimbursed for the care they gave. that caused a huge uproar. we had discussions with members. there are people that do not understand. they are not negative, they just cannot understand. why would you want to give money to your mom? she is there. it was hard to explain that. i said because she could be working. she could be a tax payer and contributing. you do not know what this is all about in particular. there was a genuine question as to 5 which you want to pick a

family person. they are family. it is not about hanging but giving them resources that they probably could not get in other ways. that was not an easy piece to get into this bill. it does not allow you to reimburse your family caregivers. the other piece be put in here was when it all rolls out, where do you go? there is some protection for those who need help in sorting out where they need to go. that is important. the other piece is we do not want to create new stuff. we do not need to develop certain series -- certain centers in the d.c. area.

what we need is documentation that you have with your hand, you have that functional limitations and a check to make sure it continues. this is your money. we think this program will be self-sufficient on its own. it is your money. it is not a federal strings attached to it. let's use existing agencies. it apart of the independent living system, you should use that. the combination of aging and disability is perfect. we want to use existing mechanisms that are out there. we want to pull together because there are other resources. it is similar to when i did early intervention. i went to delaware because nobody was doing anything. it has the highest rate of

infant mortality. the highest rate of breast cancer. i went to the governor's office. you have a pregnant teen that could be an early registrant. you can bring all of these pieces together. use the existing community centers that are out there already. the second thing is, robin is so right about the work force. i remember what i first went to get my master's degree. i've wanted to do long-term care of kids. i went to the prestigious university. of what to create a different thing. -- i want to create a different thing. long-term care nursing home is

with older people. you cannot put that together for kids. people said it did not make sense. finally we saw that young people with brain tumors really do have long-term needs. long-term care does not have to be just about 65 years of age and older. the curriculum's in the nursing schools are not there. i have argued a medic kit institutional place that is three blocks from george mason university. why you not bringing the special ed students and nurses over there?

why don't you hire some people? there are people that are functional but because of the way society has done things, they get what and to certain places. you can kill a lot of birds with one stone. how to you impact medicaid in a positive way? what can we do -- nobody takes medicaid away in this bill. this program does not impact your eligibility for that. that was big because he did not want to go into a certain model to get what you got paid on your paycheck for. how come impact medicaid? if for example you have a

fivedl's ad;'l's that is several thousand dollars a month. if you have to go to a certain facility, this case first before medicare pays. it is fair. they are still providing a roof over your head and other things. quality is another issue. the second piece is if you use a home community-based option with medicaid and the package of options in the state include the tough stuff such as desisted technology, transportation, personal assistance. -- assisted technology, transportation, personal assistance.

you still need $1,500 to do other things in your house. whatever your acute bonus injury is, this is on top of it. that is how we try to leave this. the last beasley tried to do is swear senator kennedy had been all wrong. this was never meant to put certain people out of business. we did a lot of exploration as to where this has been our of the last few years and where they are right now.

they need a jump-start in order to work. this program is not the end all be all. it is to go together with the long-term care products that are out there. we had the five years in here for a reason. it was to make sure that the government that the participation they needed. we want to see how many people we have in here before we make promises that we cannot keep. you really need to know what is going on. if you need to pull the plug, -- that is why we have this language in there. we are confident that you have to give it a shot. we believe people will vote for this. what we actually tried to do is

say that is what the five years are for. i would be smart about three crafting rapper brand -- wraparound products. there is a lot less risk to me covering the first five years than at the end. i would do it wraparound for people like connie 117 kids. this will help me all along. at the point where i may be significant, i and -- this will not help me there. they make it so that it is affordable. the question is what happens. there are ways and we will continue to save. we want to work with them.

they have increased their market share 25% by doing something like this. that is a new struggle. there are lots of different things you can do. the objections to the bill, interesting to watch as i look at the whole thing, the obsession with the finance industry. there has been so much focus on financing. half the time you have to wonder if it is financing, because everything is projection. you do not know how many people are going to sign up. he did not know what the degree of disability may look like years from now. it may go down. you do not know what that degree of disability will be.

you do not know what the adverse selection rate is. some wondered what happened with the long-term care program. i was told there was people that we thought were going to die did not die. what ever the projections were about adverse selection had to be a lot different. none of us know about it. until you do it, you will not know the types of the variables that will matter. a lot of focus on the financing model, we wonder what that is about. if you get below the financing

and talk about what that 24 hours is like for an individual or what it is like for that individual who significantly has something on the autism spectrum. what is it like for them when they cannot get a fair cuts. when you get below the financing, you have to think about what it is like. i think people get the little they afraid of that. can you keep a meaningful benefit and keep it solvent long term? that is what we want. adverse selection, you are going to cover everybody?

we are going to have episcopal big enough to enjoy that. we do not have the overnight -- overhead cost for this. there are things that you do not need to do. it attracts the middle-class population because we had the financing peace. we had to get the money for the premium. one population is kids in college. one was to make sure we do something to raise the level of awareness with the young people that you cannot guarantee.

you do not know if you are going to hit the front end of that but the board in the sand. -- bookigie board in the sand. for a parent, it would behoove you to want to pay that premium for them if they cannot pay it themself where pay some of that, because you are in the window where they are not going to get the full protection that you would normally get if something happens.

that is a phone call home. it is during the most volatile decades of people's lives. we felt strongly about that. individuals who are under poverty and working. to i get medicaid or try to continue to work? we gave it to them for $5 for that purpose as well. you have those folks covered on the sand and the middle class people covered as well. we have to see who is in the pool. we have talked to 10 ashbery's.

every single one is different. except for one guy who says you need to know all of the projections. all we have to work with its current existing data. the last issue is to say we felt very strongly that when we talk to parents, grandparents, and young people in school, they think this is important. many of it is tied up in how it is marketed. when i first started with the government's, they had a fair were you son of for your benefits. the flier for long-term care

head a woman sitting in a nice garden. that did not register with me at the time. at the flyer as someone who fell off a ski lift in colorado, i may have felt differently about that. this is about you getting a functional limitations not necessarily age related. the marketing of this together -- it needs to be marketed in a way that a guess the message out. marketing along side of what the other industries are doing. bad as important. we do not want to put anybody out of business. we want to jump-start a flat

market. it is not disability insurance. this is money over and above your income. this is not disability. that is clear. we do not know where the employers are. there is no mandate on employers to contribute. they may want to and they may not. that is how we got where we are. it is a new and different idea.

i was with senator kennedy for so long. throughout his life he would call. it was not about his sister or his mom. he realized how important it was that the care givers came to his house every day and allowed him to have what is most important in his life which was to get on that celled every day. it became of a more will issue to a people when he actually experienced it. the final phone call that i got from him not too long before he died was this has to happen. we have to put in the hands of people what they need in order to have the choice and decisions about how they want to live and how they want to die.

that is the background on how we got where we got. we gave it our best shot. frankie. -- thank-you. [applause] i do not know if we have time for some questions. >> yes indeed. [unintelligible] >> let's say somebody drops out and wants to rejoin. is it advantageous for them to see if the premiums come down or should they stay in? >> we have thoughts on what this

should look like ground that. some get concerned that people gimmick the system. they will get in and get out. we have tightened a lot in terms of when you get in and how many years of credit you can get. that is being worked on right now. it was some -- not so much they get to score better, it was more to make sure that programs that are responsible and accountable to the people that are paying into it. if the patient for five years and continue to pay your premiums, can you get out or get in? that was a big problem. we spent some time on that.

>> we have a question in the back. >> be a very clear and people being interested in having a systems with peril. in the thoughts about that? >> there is a big piece about help that is available for family members who are working with someone who cannot do it themselves. there is a big piece in there on that. one of the pieces that we have in their -- who are the people that are going to do the pay --

care? we have asked that when they submit their state plans for medicare, they have to do a survey in their state to get a sense of what is the work force look like based on what they are offering. i think we will have to pitch in part on that. we really want to help. you need to know who is out there. that is important to community choice. you cannot make the case to the state government unless you say

you do not have any people out there. you may not have anybody trained. you need to have that to make the argument to be able to support this stuff. if it will be interesting to see how much resistance we get on this. >> one more question. >> >thanks for coming to speak here today. i hope we all take a moment to understand this. so much of health care reform [unintelligible] is -- this is the one piece that

i think as a transformative quality to it. it brings a new model to the table which is important if we are going to involve. i have a question with that in mind. what can you think are the strategies to help the long- term insurance industry see the value of this? that is an important piece of the transformation. people change jobs over time. do you have a sense for how managing my benefit kind of a for a one question. -- 401 question.

>> that was one of our questions. the other was how to simplify this in a way that an employer does not have to fly, so much data on different people but how to make it more simple. the easiest way to go is to have a whole the federal plan. there has to be a place for everybody according to kennedy. this could be good or bad. we tried to write it broadly enough. we think it is the better way to

do it. there are gap products that are included in the statutory line. i think in all of the stake holders at the table at the very first meeting. the the the but the oversight should be fine. it is targeting people to say of a. that is my suggestion. >> another is a meeting going on as we speak. what do you think the cuts that it is going to survive the final bill? >> that this tough.

don't you have the camera on for me to answer that? the focus is on if you have on one bill but not the other. what we are careful to watch is the structure and the basic underpinnings from the policy objective does not change. this was not above giving a free-lance ticket to the administration to say crack whatever you want. they have lots of room to move. that is not about here is a ticket to create something new and different. we want to make sure that the contract that is in here does not get pulled apart. there are a lot of providers and

people and different groups on board. we will keep a pretty good eye on that. we believe it should go. we believe it will go at the end of the day. hopefully it will be in a form that everybody will benefit from. kennedy was so clear. if you're going to do health care reform that is not just about acute illness and and triggered if he did not give them what they need to maintain a function and prevent them from slipping backwards, you have not done anything.

the long-term care piece is help in our eyes. they are split philosophically if it is a disability bank or a long-term thing. he was cleared to sire if you're going to do health care reform you have to do acute injury and prevent people from slipping backward. decide what you are doing. i remember that. if we can control it at all, it will be she -- it will be in. >> i have a feeling that when we are in that place where we hope there is a lady at the front desk that remember our name,

there'll be a lot of people out there who will remember yours. thanks very much. [applause] we are going to adjourn for a quick 50 minute break. we'll be back here in 50 minutes for our next panel on places and care been news for people obtain care. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010] >> in a few moments, president obama on the investigation of the attempted attack on a flight to detroit on christmas day. democratic leaders talk with reporters about the health care

bill. and a form of long-term health- care services. on the "washington journal tomorrow morning they will discuss airline security. three militant anti-government protest in iran. you can call in with your questions about the federal reserve. a professor will discuss how and why the fed is -- the fed was created. this show is live every day at 7:00 a.m. eastern.

several live revested i about tomorrow on c-span. one animal speaks and the role of the military -- admiral speaks on the will of the military. we will be live from the national archives for a discussion of president nixon's meeting with elvis presley. the point of them sing together is the most requested fuddle from the archives. -- the photo of them meeting together is the most requested photo from the archives. >> this show is part of book tv this weekend. it is on c-span2.

>> not president obama will talk about security issues regarding the attempted bombing attack on a flight headed to detroit. >> good morning. i called various leaders to the white house because the face a challenge. on christmas, al qaeda will stop at nothing in their efforts to kill americans. we are determined to thwart those plants and disrupt, dismantle -- those plans and distraught, this metal, and the feet -- dismantle and defeat

them. and home, our homeland security and law enforcement agencies have worked together with considerable success in gathering intelligence. they have been disrupting plot and saving american lives. it does not come without a price. we saw this last week with our courageous cia officers in afghanistan. when suspected terrorist is able to board a plane with explosives on christmas day, the system has failed in a disastrous way. it is my responsibility to find out why incorrect that failure so that we can prevent such attacks in the future. that is why i ordered a couple of reviews.

they are reviewing aviation screening, technology, and procedures. i was briefed on the initial findings today. they are drawing on the best science and technology. i also directed my counter terrorism and hamas security adviser to lead a thorough review into our terrorist watch system so we can fix what went wrong. this ongoing review reveals more about the human and systemic failures that almost cost nearly 300 lives. we will make a summary of this preliminary report public within the next few days. let me share what we know so far. elements of our intelligence community knew that the man had traveled to yemen and joined up

with extremists there. our intelligence community knew of other red flags. that al qaeda sought to strike american targets in yemen and the united states as well. we had information that this group was working with an individual who was known -- who we now know was the individual involved in the christmas attack. the u.s. government had sufficient information to uncover this plot and disrupt the christmas day attack. our intelligence committee failed to connect the dots which would have placed the suspect on a no-fly list. it was not a failure to collect intelligence but to understand the intelligence we already had. the information was there. the agencies who needed it had access to it.

they need to bring it all together. i will accept that intelligent is imperfect by its nature. it is clear that intelligence was thoughtful and analyzed for fully leverage. that is not acceptable. i will not tolerate that. we have learned that quickly piecing together information and taking swift action is critical to staying one step ahead of a nimble adversary. we have to do better and we will do better. we have to do it quickly. american lives are on the line. of what our initial reviews completed this week. of what specific recommendations for corrective action to fix what went wrong. i want those reforms implemented immediately. we want to prevent future attacks. i know that every member of my team understands the urgency of getting this right. i appreciate that egypt and took

responsibility for the shortfall within their own agencies. immediately after the attacks, i ordered concrete steps to protect the american people. news credit as security for all flights. where explosive detective teams at airports. more air marshals on flights. and they are in cooperation with international partners. we need to take additional steps to improve security. they have reviewed our terrorist watch list system. it is not broken, but the failure to add this man to the no-fly list shows that this system needs to be strengthened. the state department is requiring embassies and consulates to include information on individuals with suspected terrorist connections or terrorist connections.

tsa is requiring enhanced screening of passengers flying through nations of interest or that have terrorist connections. someone suggested that the events on christmas day should cause us to revisit the decision to close the prison on guantanamo bay. it was always our intent to transfer detainees to other countries under conditions that provide assurances that our security is being protected. with respect to yemen there is an ongoing security sit to ration which we a been confronted for some time along without a partner. given the unsettled situation, i have spoken to the attorney general and we will not be transferring additional detainees back to yemen at this time.

we will close guantanamo bay which has damaged our national security interest and become a tremendous recruiting tool for al qaeda. that was an explicit rationale for the formation of al qaeda in the yemen peninsula. we will close the present in a manner that keeps the american people safe and secure. our previous and the steps we will take go to the heart of intelligence and elan security that we need to the 21st century. just ask al qaeda and their allies are constantly evolves in their efforts to strike as, we have to constantly evolves to keep up with them. as we saw on christmas, the margin for error is slimmer. as these violent extremists pursue new haven's, we intend to target al qaeda wherever they

take root. at our adversaries seek new recruits, we will constantly we view and update our intelligence and institutions. as they refine tactics, we will enhance our defenses including smarter screenings and security at airports and investing in the technologies that might have detected the explosives used on christmas. we are holding those accountable that work on this. they must share, and a great, analyze information as quickly and effectively as possible to save innocent lives. not just most of the time but all the time. that is what the american people deserve. that is what i will demand as president. thank you very much.

>> what is the headline from his remarks? >> it is one of urgency and immediacy fixing the problem. the president does not want any more finger-pointing by government agencies but it to the bottom of it and fix it. no agency officials were removed at this time. the biggest news to come of it was the president's announcement that there will be no more return of guantanamo bay prisoners to yemen in the foreseeable future.

there were conflicting reports initially about that. now it is clear. he will not allow any prisoners to go back to yemen until the security situation there is stabilized. >> how many prisoners are from yemen at guantanamo bay? >> 198 detainee's left there at this time. about 90 of them are from yemen. some are likely to face prosecution in the united states in criminal court for a military commission. several dozen have been cleared for release back to yemen. at the moment, the u.s. does not think it is feasible to send them back because of problems we have had in the past of escapes

were returning to the battle on behalf of al qaeda. >> what did the president said about closing guantanamo bay? >> he is committed to closing it. half the prisoners cannot be sent back to their home country. it is a tricky situation. the president has said that he loves to close the prison by the end of the year. it depends on the situation in yemen to a certain degree. >> the president made the remarks after he reviewed the security lamps -- security lapses related to the attempted bombing of christmas day.

any indication on what the next step will be? >> he outlined some of the security changes. they have not given clear indication. the president wants to have a system in place to make sure that that are able to gather this information from different agencies. in terms of new statistics on how to guarantee it in the future, we did not hear those from the president today. we heard more about putting people on to watch with an airport security measures including new searches required of all travelers coming from 14 countries that the u.s. deems terror-prone. he said he does not think the system is broken it just needs to be strengthened.

>> we appreciate your time. >> happy to do it. >> britain's secretary says the british air force will introduce new bomb detection equipment and body scanners in the coming weeks. and there was talk about closure of a center in in in yemen. this is about one hour. urgent question. the foreign secretary, and urgent question, namely, that he will make a statement about the situation in yemen, including the closure of the british embassy and the position of british citizens in yemen.

>> i will address the broader picture. the government has been concerned about the situation in yemen and the number and scale of challenges faced by their government and people. increasing insecurity and instability and yemen opposed a threat to the gulf region, to the wider middle east and to the u.k. over the last 18 months, the situation is of growing concern to her majesty's government. it includes working with international partners. in september, 2009, a development of a renewed country strategy for yemen. this is -- this is currently being implemented. it covers four areas. support for democratic political structures. addressing the causes of conflict thirdly, building yemeni ability to tackle security issues. and helping the government to deliver the functions of the state onshore and offshore.

to further strengthen the support for the government of yemen, the prime minister announced on january 1 that the u.k. will host a high-level meeting later this month. the meeting will focus on galvanizing international support for devin's fight against terrorism and coordinating assistance to address the economic and social factors underlying extremism. mr. speaker, the symbol of the government's long-term commitment to yemen -- they signed a 10-year partnership arrangement with the government of yemen in august, 2007. the u.k. development fund is fully allied to our yemen strategy and to the priorities of the national reform agenda. we will spend 25 million pounds in fiscal year 2010, and depending on progress of reform of states in yemen, up to 50 million pounds in 2012. the government of yemen is

embattled on four fronts. first, the troubled rebellion in the north. separatist movements in the south. economic decline across the country, particularly important in the context of -- the population of yemen as foreseen in the near future. also, the growing threat from islamist terrorism in the form of al qaeda at, which finds safekeeping in -- safe haven ad yemen. it detracts from the government's short-term efforts to address these priorities. as a result of security concerns, the british embassy closed early this week on a precautionary basis for two days. the embassy is now open and staff is back at work. the public services section, the set and consular section, are closed. this is under regular review. i discussed it with our ambassador yesterday morning. it is not unusual for embassies

to close during times of heightened tension. in 2009, the british embassy closed in the capital city on over a dozen occasions. it would not be right to comment on the specifics of this closure, but i do assure the house is kept under regular review to ensure services are maintained. the embassy maintains regular contact with the british community, and with a british nationals who are registered with the embassy. the overall threat level in yemen has not changed. as we made clear and the travel advisory, the threat from terrorism is high and remains of concern. we continue to recommend against all non-essential travel to the country. >> i refer the house to register. my personal interests, having been born and yemen and lived there for nine years, in welcoming the london conference, will the foreign secretary state precisely what additional support has been given to yemen as a result of

this recent initiative? can you also confirm that all the money pledged to yemen in november, 2006, in london, has been paid over. can we stop referring to yemen as a failed state? çit has the capacity toç failf britain, america and the arab states do not support it. could we make sure that the foreign secretary visits this country as soon as possible? >> mr. speaker, three parts. first of all, the london meeting will not be a conference. i do not think what is -- that is what is needed. some 5 billion pounds was pledged at the london conference and 2006. a small portion of that has been ini] part,ç because of concerns about how the money would be spent. there are other issues raised. 40 percent of it has been assigned an 81% allocated -- a

small percentage has actually been spent. in terms of his attempt to send me to yemen, i cannot quite promise them that. my hon. friend, the minister of --u! will be on ça wrecky toçn çnext month. the conclusions of the london çmeeting in inappropriate way. >> mr. speaker, may we welcome on behalf of the opposition, the calling of the conference in london on january 28. agreed that yemen as a fragile state, rather than a failed state. it matters to british security. thereo7k are three setsç of questions. on the closure ofçç the embas, is the confidentç that the rigt level of consular support can be given to british citizens and officialsç in yemen?

in the event of further closures of our embassy, and plans are in place to offer them protection? for u.s.-u.k. support of the counter terrorist police force, and a yemeni coast card operation, -- ç[unintelligible] çóbut specifically, does this refer purely to financial support? or to any actual assistance on the ground in the form of trading? what is the timescale for the delivery of this support, and when is that you knew it expects to be up and running? -- the new unit expect to be up and running? on the part of other gulf nations that may be willing to work with us on this initiative. third they, at yemen cannot be viewed solely through the prism of an al qaeda problem. the foreign secretary refers to a mixture of issues.

çit is an internal conflicts, fuelled by political grievances, poverty, corruption, competition over depleted natural resources, and requires political leadership from the government as well as international assistance these issues -- can he assure us that these issues will all be addressed at the conference in january and will continue to be treated as a priority by his colleagues? will it also focus on the dam and the government's responsibility -- the yemeni's government's responsibility? >> i am confident that the right procedures areç being followedn terms of consular support for british nationals. the yemeni çdiaspora and britan as long standing -- in britain is longstanding. çthere is some need for customr

support, but i am assured by the ambassador that is being taken care of and the appropriate way. çspecifically, toward network, which operates in many countries, -- the warden network, has not been met so notified. in respect to the work goilg on with the yemeni authorities, money for training, which is the money for training, which is the important part of >> we will be discussing with a range of them whether there is the way they can support this uk/u.s. effort. we will look for appropriate ways in which to use the skills and expertise that come from other countries. there is a need to maintain the british program.

most of the grievances that exist in yemen are of local nature not a global jihad. [unintelligible] >> the actions and working with allies in yemen and other forces -- in supporting action against al qaeda in human, we are ensuring that local people are not inadvertently ended by our actions -- alienated by our actions. are we impressing upon them the

importance of avoiding civilian deaths and building a sustainable action against al qaeda? >> makes and important point. . highly relevant one. there has been a very wide welcome across the gulf, and within yemen, for the fact that the london meeting will not simply focus on counter- terrorism. that might play into the dangers that the hon. gentleman is referring to. the into this that is al qaeda of the arabian peninsula -- tghe xdhe incubus of al qaeda in the arabian peninsula should not become a rallying point. they become the victims. he is absolutely right to insist that the economic, social and political issues that are at the heart of yemen's development do need to be addressed. i think that yemen's oil wealth

i think that yemen's oil wealth is likely to run out in 2015. the dangers of water scarcity are very real. these are issues that are not amenable to counter-terrorism solutions. they require a much more deep- seeded and -- that is why the fourth priority we mentioned of the function of the state is so important to these questions. >> the foreign secretary mentioned the radicalization. we undertake a very close talks with the saudi arabian government, which makes some of the westernized countries seem unorthodox. some of these contacts seem to be working and i think we need to learn from that. >> the saudi arabian program that was featured today it was one that i visited last year in saudi arabia. there is a counter radicalization program. it is extremely innovative.

i met my self a failed suicide bomber, one who had been inveigled into driving a truck -- and failed. it is not a laughing matter, since he killed a lot of people in that truckee was driving. he did not know what the contents war. she was going to the program. there were a number of other people going to the$ogram -- he was going to the program, qincludingç religious instruct. there are larger, innovative profuqmeáqáurns -- in regards to return to normal life after the program. i congratulate the saudi arabian government in this program. >> mr. speaker, can i declare an interest -- i visited yemen a couple years ago. i found a very impressive foreign minister read things britain has a key role to play

in that country. what i also found is that the electoral gains made by radical islamists have been in those areas of the greatest party. what we need -- can we also do more to eradicate and rehabilitate their breeding grounds? >> sorry to sound like a stuck record, but the hon. gentleman makes an important point. those who in çthe newspapers today are alleging we are çwasting ourç money and spendg development money and anti- party messageñr --w3 programs. they are actually wrong. çççthe fact thatç they enjo- party support is a positive he is right, that ifç we want o w3ççkçstop yemen becoming a e çdangerous for the ground for ççterrorism, it needs to devep the sort of life chances that you and i take for granted. >> at enormous cost and a loss

of british human lives, we joined america at in an invasion of iraq and afghanistan. before we commit even more human lives to another nightmare, should we consider the possibility of having an independent, british foreign policy? >> we should certainly have a foreign policy that is decided independently by the government and people of this country. what we should not have is an isolated attempt to workq on its own. i am proud that we are close partners of the united states, of the european union, and a large number of countries in the gulf who are concerned actually, the attention we have been paying to get men over the past 18 months is a significant product of thei] growing concern in 2008 from countries in the gulf who wanted british help because of their concerns about the situation in yemen. we are not unwelcomew3 helpers n

yemen. we're not trying to recall a nice yemen. --ç recolonize yemen. >> whilst i welcome a short discussion about yemen, we are having this discussion because of al qaeda. would it not be instructive of the government to produce a document or hold a london conference and invite international partners to talk about the international strategy to talk about -- against al qaeda before we have the other countries where al qaeda is offered -- operating but not necessarily in the news at the moment? >> i think he would be one of the first to recognize that simply to talk about al qaeda and not distinguish between its senior leadership based in afghanistan and pakistan, the al qaeda of the arabian peninsula, al qaeda and in other areas, there are distinctive issues

related to this senior leadership and the franchises on the other. there shouldç be a steady to debate and the more the better as far as i'm concerned. there was our recent meeting with parliamentarians on the situation in yemen before the e is a thrivingç all-party parliamentary group, chaired by my hon. friend that speaks to the close links that exist between britain and yemen. long a that continue. >> is a significant proportion of terrorists turned out to be radicalized here inç britain, ratherw3 than niemen ?rd elsewh, should not t prime minister also be considering the radicalization that takes place here? -- rather than just in yemen. >> there have been a large number of meetings. -- not just within government

but all around the country to address this issue. >> mr. speaker, i agree with the foreign secretary about the importance of aid in removing what i call this courage of these spots where terrorism-- the scurge were the spots of terrorism can rise up. they described as yemen as fragile. çcould the foreign secretary indicate just how widely supported is the government of yemen of cross all the people, bearing in mind the tribal conflicts in the north and the separatist movements in the south? >>çç far be it from me it to a lawyer for the right hon. gentleman, but i thinkç he said that yemen is fragile, rather than the government is for agile. in his defense, or at least an explanation of his position -- the government is fragile.

the president is currently in his second term of office. the constitution prohibits him running for a third term. parliamentary elections are due in 2011, in yemen, and they will clearly be a massive challenge. one of the issues that will need to be addressed our democratic elections and the ability of people to express their opinions. the number of citizens committed to violence, whether through the movement in the north of the separatist movement in the south, with links to al qaeda, is a small minority. >> all over the world, our armed forces and our aid budgets are stretched, in afghanistan, in pakistan and in somalia. why has the prime minister chosen to take a lead in yemen or in our resources are stretched? is it better for the u.s. to

take a lead? >> so much for an independent foreign policy, mr. speaker. this country has longstanding history with yemen, and i think that gives us an important role. secondly, we are in a group of donors with the united states, with the germans, with the dutch as well, and with the saudi arabia into our preeminent donors. in terms of the stretch, we have been careful to make sure that in our funding and yemen we only spend what we know the government has the ability to properly spent there. he is right that there are a range of other problems. somalia is addressed best through the amazon security work, but on the political level through the un security council. the meeting that has been called an the other forms of corporation being established the fits the situation in yemen. somalia is rather different. >> international aid funding

which they have promised -- it pales against what the oil-rich countries should be providing shouldn't her majesty's government make clear -- shouldn't her majesty's government make clear how much they should spend, rather than spending millions of pounds? >> i am not sure that the government spending money on skyscrapers is what he is referring to. some of the largest pledges at the 2006 conference were from gulf countries, not from western countries. it is important that those pledges are fulfilled. which of those pledges that? the bank paid? that is a curtain in point in regard to this. -- which of these has been paid? it is not to say that we have the biggest program. it is to explain that we have the berdych program.

he has a right to say that this initiative -- we have a british program. he has a right to say that they have put us on the alert about their needs third . >> secretary allen johnson. >> with permission, i would like to take a statement on the failed attempt to destroy a passenger plane at the detroit airport and its implications for national security. on december 24, abdulmutallab, the nigerian citizen it traveled from lagos to amsterdam, where he boarded the 2 flight53 2 detroit -- flight 253 to detroit. on the way, he detonated a device on his thigh which resulted in a fire.

he was subdued by flight crew and passengers. remains in custody in the u.s. -- many countries are doing everything they can to piece together his movements shortly before this attack and are considering what urgent steps need to be taken to prevent further attacks of this nature. it is an issue of grave concern at that the explosive device was not detected by security in nigeria or in the netherlands. as has been widely reported, he attended university college london between 2005 and 2008, where he completed a degree in engineering. during this time, he was known to the security service but not as somebody engaged in violent extremism. his family and friends have stated their belief that he turned to this during his time in yemen. from the information we have currently, it is not possible

to chart with absolute certainty his exact movements after he left the u.k. 14 months ago. he is known to of spent several months studying international business at the university and dubai and in august, 2009, he traveled to yemen where he is thought to have stayed until december before returning to west africa. he came to the attention of u.k. authorities again on april 28, 2009, when he applied for a multi-entry, student visitor visa to attend a course provided by discovering life coaching, based in east london. the u.k. border agency refused the u.k. border agency refused to his application discovery did not hold the approved body. they were not told to sponsor the international students. since march 2009, institutions to our sponsors or hold a valid

accreditation are permitted to bring in short-term foreign students. universities and colleges are able to demonstrate that they can benefit the students who are seeking to study in the uk. and the institutions are able to bring the students in from 4000 to approximately 2000. his name was added to the watch list. in light of the questions, i want to set out the steps for aviation security. and i want to talk about the measures that we used to prevent radicalization in the universities, and the actions we have taken to disrupt al qaeda in the countries where they are active to prevent the future terrorist attacks.

it is of great concern that he was able to penetrate the airport security. the device that he used had clearly been constructed with the precise aim of making detection by existing methods extremely difficult. underwent a security check at the airport in amsterdam, as do all passengers transferring from nigeria to another flight of the the it -- although theç airport was using some of these in trial, there were not used for that flight. he passed through the metal detector. however, certain types of explosives, without metallic parts, which can also be concealed next to the body, cannot be detected by these technologies which is the reason why airports also search

passengers at random. to defeat the terrorist threat requires constant vigilance and adaptability. a great deal of progress has been made in enhancing aviation and border security since 9/11, but terrorists are invented. the scale in nature of the threat changes and new technology needs to be harnessed to meet new threats, whilst minimizing inconvenience to passengers. last year, we issued a new public guidance to the industry on our technical requirements for screening and the detection of improvised explosive devices. . .

no single measure will the feed all the terrorists and there is no single thing that will be effective. airport security is multifaceted and will have to adapt constantly to deal with these threats. we intend to make changes to the aviation security regime. the passengers are familiar with having their baggage tested for traces of explosives. we will direct the airports to increase the number of passengers who are searched in this way an an increase of passengers being there will be a delay but the traveling public will appreciate the reasons behind this. and we will try to tighten the security screening for the transit passengers, and we will operate the direct flights to the uk. standards and airports operating

direct flights to the u.k. there will also be an increase number of the dogs to had to our capabilities. the first canners will be deployed in around three weeks at heathrow. over time, they will be introduced for widely. we will be reviewing all airports to introduce explosive trace detection equipment by the end of the year. the best way of doing all of this will be dealing with the operational and privacy issues involved. we've started training airport security staff and behavioral analysis techniques which will help them to spot passengers acting unusually and target them for additional search. beyond this, we examining -- we are examining whether

additional passenger profiling could help security. we will be mindful of civil liberties concerns and aware that identity-based profiling has its limitations, but conscious of our overriding obligations to protect people's lives in liberties. these build on the substantial progress we have made in recent years to strengthen our borders, including protecting people in transit against the watchless will be 95% complete by the end of the years. it makes is one of a handful of countries to have the technology that can carry out advance passenger checks against our watch list before people travel to the u.k. those who apply for rugby's the will have to provide fingerprints and their records are checked against the new watchlist which holds over 1

million records of known criminals, terrorists, people retry the into the country illegally, or those who have been deported, and those considered to be a threat to our security. through the e-borders program, we have made 4900 arrests since 2005. in addition, the uk borders bath working with airlines prevented over 65,000 adequately documented passengers from travelling to the u.k. during 2009. mr. speaker, addulmutallab's failed attack highlights the importance of information sharing between the various agencies about people who pose a threat to our security. you can watch list is managed by the u.k. border agency and incorporates intelligence from the law enforcement and the

security and intelligence agencies into a single index. nevertheless, although the integrated approach works very well, we want to see if we can further strengthen it. we will be conducting an urgent review with the robustness of our watch list. it will report to me and two week's time and i will report the findings subject to security restrictions. there is a concern that addulmutallab's radicalization may have been fuelled or started at university college, london. the tolerance promoted in higher education are one of the most effective ways of challenging views which we may find abhorrent but that remain within goal. however, we know that the small minority of people supporting

violent extremism have actively sought to influence and recruit people through targeting learners and colleges and universities, and we must offer universities guidance to help prevent extremism. as part of a measured and effective response to the threat, the department of business innovation and skills have published guidance on managing the risk of violent extremism in universities, and will work closely with universities to provide targeted support. alongside this, each university has a designated police security contact that university management can discuss concerns with. the strategy works closely with the higher and further education secretaries and has a full-time officer. his family believes that if left

-- he turned to extremism after leaving the u.k. but we need to make sure that we continue our efforts to stop radicalization of young people in our universities. finally, mr. speaker, i want to say something about our work internationally and the steps the government is taking abroad to disrupt al qaeda where ever they are. our success in tackling the international terror threat depends on strong relationships with our international partners. in our efforts to fort al qaeda, we have a longstanding productive partnership with the u.s. i am not prepared to discuss in this particular case about what we established -- what we shared and wind. we do not routinely comment on such intelligence matters. moreover, some of these issues are still current and are highly sensitive. however -- however, i would like to clarify that whilst we did

provide information to the u.s. link to the wider aspects of this case, none of the information we held or shared indicated that addulmutallab was about to attempt a terrorist attack against the u.s. i spoke to the secretary of state and the homeland security. we discussed in the light of this failed attack that we will work together with our international partners to maintain confidence in aviation security and deepen our partnership to disrupt al qaeda's activities overseas. forced out of afghanistan and under increasing pressure in the borders of pakistan, affiliate's and allies of al qaeda like al qaeda in the arabian peninsula group claiming responsibility for the detroit of -- bombing have raised their profile. then again demonstrated their

intent to attack innocent people across the world. the aim of our counterterrorism strategy is not to reduce our own vulnerability alone, but to disrupt those organizations that pose a threat to the u.k., whether at home or abroad. al qaeda will take any opportunity to exploit instability, whether the threat is in somalia or yemen, pakistan, iraq, or afghanistan. we must support governments and work with partners to address both the threat of attack as well as the underlying causes of extremism and instability. we have been working with the yemeni government, as my right honorable friend, the foreign secretary, has just said through law enforcement and security apparatus to disrupt al qaeda and denied their safe haven in yemen in the future. we are also one of the leading donors to the development of the country, standing at 100 million

pounds by 2011. we recognize the need to strengthen further our partnership with countries in the region and beyond. that when we can coordinate against al qaeda more effectively and find greater support for the many people to reject extremism. international cooperation is critical to making what is a global threat, the coming together to discuss yemen will be an important step toward security there and across the globe. mr. speaker, it is important to reiterate that this was a failed attack by a nigerian national on the u.s. by someone who was refused entry to the u.k. and who it seems was radicalized after he left this country. however there are lessons to be learned by the international community and the measures that i have outlined will provide the u.k. greater protection from terrorist attack. along with our work overseas and

our international -- and with our international partners, enhanced airport security and more thorough collation of intelligence, we will be able to strengthen our efforts to attack the root cause of violent extremists on and reduce the threat of future attack. i commend the statement to the house. >> thank you, mr. speaker. i am grateful for the home secretary providing me an advance copy of this statement. let me start by dealing with the issue of airport security. i think we all have said that we have learned lessons from their recent plot, happily unsuccessful, that additional security measures will have to be taken. the use of more sophisticates -- sophisticated scanning technologies are inevitable, though we have to make sure that sensible measures are taken to maintain privacy. but the statement is actually ambiguous about scanners. can he be clear, does he plan to make full body scanners compulsory at all u.k. airports?

kenny clarify the situation also with the european union over the use of e-borders? we also believe that it is necessary to take a more intelligence-led approached, all much security as well as pledging for suspicious behavior among passengers. the government will have our support in taking prudent measures to protect passengers. these must under be -- these must be under constant review. however, mr. speaker, the percentage planning themselves should not be the home secretary but the prime minister for it twice in three games the prime minister has been caught out making false claims about the contacts made between britain and the united states all over the security threat to our airport. he admitted to the bbc that

supposed discussions between him and president obama of about the bomb plot about the situation in yemen had not actually taken place. then yesterday he claimed that britain had supplied intelligence about the@@@ @ @ @b the on secretary -- does he agree with me that for the prime minister, that they will spend the intelligence information as a relates to a terrorist threat? this is unacceptable behavior by the man who is leading the government. the home secretary has told the house this afternoon that they have an established principle that we do not routinely, and on intelligence matters. -- matters. so why did they break that rule this week? the secretary also agrees that

this is damaging to the most important intelligence relationship with the united states that information be disseminated by downing street in a cavalier way. ation to be disseminated by downing street in such an inaccurate and cavalier way? mr. speaker, this entire house will be relieved that on this occasion the bomb plot was unsuccessful. it will serve as a strong reminder to the governments across the world of the ever- present terrorist threat and we all need to remain vigilant about that threat as well as united in a determination to defeat it. it is also worth saying that the threat from a small group of islamic is remiss -- extremists in no way reflects the views of the vast majority of decent months and people around the world. people who have always been victims of terrorism of the decades, we must band together regans that thread. that task has not been helped by the actions of downing street in

recent days. >> mr. secretary. >> mr. speaker, i do regret the fact that the honorable member uses this very tense time to score cheap party political points. to use this issue -- mr. speaker, i saw lots of faces on the benches opposite appalled that this situation should be used to make personal attack on the prime minister. the honorable member on the raised three points that i believe are relevant to this issue. the first in terms of the number of all body scanners. what we need to do know is work with the airline industry to decide how many and where we can locate these scanners. as i said in my statement, we will have the first ready at heathrow within three weeks. there is a limited capacity to

manufacture these and that these employees and also get the authority and the agreement of the different airline companies and their input into this. that will become much more widely available. the honorable member also talked of the eu's situation. that was clarified before christmas and there will be no e.u. community issues about the transfer of their permission. it still needs the country's transferring that information to agree about transferring techniques, but there is no e.u. issue which the commission it was originally looking record and the third issue, which was about our use of intelligence and about our cooperation with united states. the prime minister was absolutely right, as i said in my statement, that we did share information with the u.s. none of this information or the nature of that information and the affirmation itself that we do not routinely comment on, but none of that suggested that addulmutallab was planning a

terrorist plot. incidentally, i met jane lucas and mentioned that statement today, and she did not mention this issue at all this morning. this is a productive way to deal with this issue. to deal with these issues, and there is absolutely no relationship in the world stronger than the relation between the u.s. and the u.k., particularly on counter- terrorism where we work together and we will continue to work closely together in the light of this latest threat. >> chris him. -- hume. >> i thank the secretary for statement. the announcement that scanners will be rolled out its welcome. but there are several questions to be raised, and can they -- and can confirm that all body scanners would have detected the substances carried by umar farouk addulhutallab?

why is it taken so long for him to act, given that they are already in trial, and four are reported to be in storage at heathrow? and the third question is whether he will respect those who may have a deep felt objection to be -- to the scanners to opt instead for a pat down? and can he give assurances that the images will not be stored? profiling -- what does that mean? does he mean additional services for suspicious -- those with suspicious travel partners? there will be several in this house that will dead. it means stopping every one that looks at asian, then he will alienate those two in -- his cooperation we need. then there is the information's sharing, which the home secretary really cannot commit -- dismissed by saying that the government does not comment on

intelligence matters, particularly on recent developments from downing street? can he confirm that downing street told the u.s. that the bomber had linked to extremist groups, and that he was placed on the u.k. watch list? and a lot of these contradictions and the open spat with our closest ally, what measures has the government taken to improve the liaison with the indicted states or possibly with the prime minister's press operation? given the detroit bombers layover, were the dutch authorities shared with our european -- was the affirmation shared with our european partners, and how can an eu country be informed of such

information? do we routinely share information about our watch list to our unity and car parts -- european counterparts? and do these systems need to be improved? >> mr. secretary. >> on the issue of scanners. what they had been effective in relation of the time? the indications are, given where the six bosun was place, with them o -- with the explosive was ta -- where the explosion was in place, there was a 50% chance of being detected. i think that we need to see the next wave of technology with explosive detection as well as the body imaging issue. we need to see that ahead very quickly.

i do not accept that we took so long that act. this happened on christmas day and over the christmas period we have been discussing -- my colleagues at the secretary of state have been talking about the availability of this equipment. there was one body scanner at manchester. there have been a number at heathrow on a trial basis, but whether they are serviceable or whether they need to be operated on to be serviceable, is still an open question. the issue of privacy, mr. speaker, is going to be an important issue, but given that all of the images are destroyed immediately, given that the person responsible for the scanning is separate in a separate room. there is a version that glass co as well. there is no immediate contact between the person doing the imaging and a person being imaged.

i think we have to put these considerations -- they are important, but i think that we can actually ensure that those concerns will be satisfied. i cannot see a situation where people can simply object to a body scan. perhaps not as the first line, but as the second line on iran the bases as part of the defense. the honorable member mentioned the important issue of profiling. i said in the statement i recognize the sensitivities here. anyone who looks at the case in 1986, a pregnant woman in faded by her syrian -- inveigled by her syrian boyfriend to carry a bomb on board, the name would not have alerted anyone, but nevertheless the issue of whether we can deal with some of the sensitivity issues must be part of l%9eñ any defense

we can find to ensure that this gap in our defenses, which thankfully was unsuccessful but which was found, and we need to recognize the concerns and the civil rights issues as well. on the issue of information sharing, we shared information all the time. we share information on a routine basis and you -- and the u.s. share information with us. we did not inform at the u.s. that addulmutallab was on our watch list because he refused a student visa, because that was an issue conducted without any concern that he was coming to commit a terrorism incident. it was about an immigration issue. we would not share that routinely with the u.s. but we share other information with u.s., and we share this information routinely with our european union partners, although if there are concerns about counter-terrorism, it would not wait for a watch list

and it would not wait for the plane to be taking off. it is outside of europe where we have the problem. within the european union, we have a very close relationship which means that we deal with the security issue straight away. we do not wait until they are trying to get on the plane and other countries. >> order. several members are seeking to catch my eye. like to accommodate everyone. the number should be perfectly manageable. level me remind the house that there are two further statements to follow. each honorable member should ask a single, short, supplementary question, and that the home secretary will reply within equally economical answer. >> the home secretary is right to consult with the airline and measure the response, and we

ought to have these body scanners. the international cooperation aspect is the most important. are there any more lessons to be learned as to how we can improve the situation? >> doubtless there are, and i recognize my right honorable friends expertise in this matter. i said in relation to the watch list, we think this integrated watch list so that there's not a separate -- in some countries there is a separate one for security and for policing in crime, and for those who lost their passports and immigration issues, and integrate the watch list and with e-borders continually coming onstream, we can deal with this that has taken off. given that addulmutallab was not tried to enter the country but blow himself up before it landed, and that does not matter if this -- and it does not

matter what country was his destination. i would be the last person to appear complacent about this. at the prime minister said, this is a wake-up call. every attempt must be picked to pieces of that we can find anything we can to strengthen our defenses and that is what we intend to do. >> mr. taylor. >> does the home secretary realize that scanners cover all white area? some require you to go through a box and others actually can do it remotely in airport lounges or railway stations. can the government institute a research program -- several british companies are involved in this -- but we need to stay ahead of the terrorist and not deploy after every incident? >> the honorable member raises a

valuable point. we are dealing with smith industry shortly and talking to the document that we repeat -- that we produce last year about our security minister in 2009, it was specifically aimed at the scientific community innovators to get this moving and to find new ways to deal with this. i think that the important part about this is that there is a big part of the british technology here said that we can actually exploit it and insurer -- which is one reason to talk to the airlines -- and that soul -- and you're absolutely right. there are a variety of these scanners and we need to use them effectively. >> john bolwheaton. >> can i welcome the emphatic way in which the home secretary emphasized that there is no single magic bullet to solve these problems?

in light of recent media in light of recent media comments, p this will require a range of search procedures and the right hon. gentleman said that this will require constant innovation in everything that we do. i will ask the home secretary if he will build on what was done, and he will make certain that a partnership of the government's and the private industry is given more resources so that we can stay ahead of the terrorists and venting -- preventing the new ways of terror. >> i agree with this. this is another reason to redouble the efforts to stay ahead of the terrorists. this is about reasonable efforts to stay ahead of the terrorists. we will not deal with the issue

of body scanners alone. sniffer dogs every day, in looking for ptpn, and the use of behavioral detection -- all the techniques that we can use, even then we will not be 100 percent. we can never guarantee 100% safety. but there are a lot of people out there waiting to innovate and to work and to provide equipment in a technological capacity that can move us to the next level. i believe that that is really the main lesson of detroit on the 25th of december. >> mr. robert keep. >> willie acknowledged a debt that we owed to the ministry of defense personnel and other start reduce servants working at one company in my constituency about terrorism who are responsible for all of the

day-by-day innovation which goes on in terms of science and technology? and willie talk to the ministry of defence to have tremendous budget problems to ensure that there is not only no cut in the defense budget as it affects this, but that they should have all the resources that they need to counter terrorism? the boilers the home secretary. >> the honorable member is a great advocate for his constituency. i am talking to the defense secretary perry this is a cross-government initiative. we are all working to do this using all the agencies of our government. >> aviation -- what new steps are being taken to link intelligence information with the best system of security at individual airports? babblers mr. home secretary. >> my honorable member -- my honorable friend is a member of

the transport secretary committee. talking to jay lucas today, we're talking about the lessons from it and we're still talking through -- there was a view that we should go to brussels and the opportunity of the spanish presidency very interested in this matter comes up in a few weeks' time. more and more we're centering on that, the opportunity to get transport ministers, homeland security ministers, perhaps defense ministers as well together to talk about an integrated program as to how we can act internationally. my honorable friend is absolutely right. by its very definition, a nigerian coming through holland to detroit with ramifications for a much wider set of countries, we need to deal with his senate -- with this internationally.

>> mr. speaker, to organize the -- who authorized the downing street spokesman to talk about the bomber? >> i will not get into who authorized to to say what. what the prime minister said about exchanging information with united states was absolutely right. not all of that information remotely -- not that informational remotely indicated that he was planning an attack. >> with my right honorable friend considered a central reporting area for members of the public who spot lapses of security in airports in which they are traveling coming in to the uk? the boilers mr. home secretary. the >> i will consider my honorable friend's suggestions. there are plenty of opportunities for people to report these things. there was a program over

christmas about the emergency service being misused. there is a problem and a security problem, that is one cause of action and there are others. my honorable friends makes a good point and we will look away to make it easier for the traveling public to report any suspicious that they have. >> we have the only airport in the u.k. sector to terrorist attacks in scotland. can the scottish airports expected be a first line for the body scans and can he assure me that he will be working hand in glove with a scottish government to ensure that the scottish airports are safe as possible? >> i can answer the honorable member on both of those points. we need to talk about which airports for three i believe he wrote, given the huge amount of transit -- because we're talking about transit passengers as well. addulmutallab was a transit passenger in holland and was not searched possible -- properly.

i believe the discussions have already started with a scottish governments. >> mr. speaker, if we're concerned with the immediate threats obviously, but i -- can i pass on a warning given by a constituent who works in airports that there has been talk of introducing competition between terminals. with the on secretary ensure that security always comes before competition? >> the home secretary. >> i can give that assurance. i am not sure to what the honorable member is referring, but in terms of providing security, no matter the terminal, the absolutely -- the absolute priority is security not competition. >> there have been many hill had expressed concern about the activities of schools and the

role that they play in that radicalizing man like addulmutallab. can he confirm that schools will be swept up in those and that the matter of this schools will be -- the schools will be properly addressed? >> addulmutallab himself would to a british school, but this is an important issue that i need to discuss with my right honorable friend the foreign secretary to make sure that we're doing not only for local security but to prevent this radicalization taking place in the first place. with a that is in this country or abroad. >> during this debate there has been some very interesting proposals about investing in research about the technology required to detect terror. i am concerned, although the home secretary acknowledge the risk of identity basis is for profiling, that there will not be sufficiently robust -- robust research into the consequences

on young men who are muslim or asian who think that they are expected to be paid in a certain way and therefore say, why don't die? can he assure the house that there will be very robust research into the potential consequences of identity-based profiling before any such process is introduced? >> i can give my right honorable friend that assurance. behavior detection is different to profiling 3 behavior detection is something used by the british transport police. they are well trained to do that, and it is observing individuals and how they act around uniformed officers that gives certain signs away about whether they should be -- that is a preliminary to them being researched. it is different on profiling. i recognize that just the sensitivities and the civil liberties issues raised from the liberal -- the liberal democrat bridges -- ages, but we were talking about the terrorists

being one step ahead, and if they think there is a profile that it escapes this, and it is our main weapon against them, then they will use that, whether it is pregnant women and or whoever else a gentleman like me. i think that is the other danger of profiling and we need to be very careful, and i am acutely aware of that, but it would be strange that if in response to detroit we did not cover all the different elements and all the different options and it thoroughly air -- and thoroughly explore them. the dollar's been wallace. >> is it rich that the government has come here, year after year after cutting the defense budget, and what had [unintelligible] we have to go to the americans to get the funding because this government cut the funding. could the hong secretary please tell us what actual concrete resources he is going to put

into further developing technologies and to make sure that our borders are secure? >> i know the honorable member has some experience in this field. i do not understand the criticism of this government in terms of what we have invested. he is no longer in this place but the opposition benches, he was continually praising the government for the science and innovation project. when i was secretary of state at the old dti, half of my budget was signed. it was frustrating at times because i could not touch it for a good thing. criticize us for a lot at this, but did not criticize us for the budget. >> helen my right honorable friend consults and communicate changes that are made and profiling? it is difficult because these changes need to be made in a way that does that actually trigger, as you suggest, the knowledge of

people that we're doing this, but it is important to avoid unnecessary communications as well. >> i take my honorable friend's point. there would be no benefit from even studying the use of profiling if we were not sorting and did groups representing different ethnic minorities in this country. we have to take a bus along with us. -- we have to take them along with this. there will be different views in different communities among different ethnic minorities. all i am saying that this dispatch box, mr. speaker, is i think it would be irresponsible not to let it weather profiling can play a part in strengthening our defenses. >> to search people more thoroughly and introducing more body scanners, we will need more space and more employees at our

airports. seeing that our airports appeared to be fully cram, will he make it clear to the airports that security matters have to come first? >> maybe the honorable gentleman is inviting me to change the use of space at airports. this is one of the important discussions we ought to have with the airport authorities and with the airlines. how we physically can do this properly with the minimum of inconvenience to the public, and ensure that people can go about their daily business, that is a very important part of these discussions. >> then we have stronger action for people who are expected of promoting extremism and those to be suspect becoming radicalize, and can we include in that list those people who go on offense

of marches? >> we always keep these issues under the. it is important that we do not take action -- we are a democracy. on our university campuses, there needs to be proper debate. because people have the views that are found of all right but not illegal, it would be applauded for us to be heavy- handed in that respect. what we do to prevent is to strengthen the institutions to help individuals, to provide the information and the facts and the advice to those who want to counsel some of these radical views. as part of this, of course, we deport and seek to deport a lot of people. there are many cuing up for deportation at the moment. they had their right to be the use of the european court, all of that is important, but provided we have done our job, those people will be deported. >> given the strong links that

umar farouk addulmutallab had in this country, will the british police be able to interrogate him about those leaks? >> all that i can say at this >> all that i can say at this stage, mr. speaker, is that two the police were taking action in this country. we do not talk about the current police operations. we have to wait on them to come to a conclusion. the british policeman want to ask questions and we will have to see how the operation is going. >> i have constituents expressing concerns about the health risks without the use of the scanners. could the home secretary do anything reassuring on the public record. >> because of the radiation, my

suggestion is that there is less radiation for a body scanner and what you get from actually flying. as i have mentioned, i think that we can probably do more but at the moment, the fact is that all the images are destroyed immediately. the person operating the machine is remote from the person being scanned. they are anonymous in terms of being scanned. it is difficult to get across the privacy issue, with where he was trying to hide his explosives. this is the way that the terrorists tried to get around these issues. we will have to be a little bit less delicate about privacy in order to counter this. >> order. .

you can collin with your questions about the federal reserve to professorñ meltzer. he will discuss how and why the fed was created and its role in the system. live every day at 7:00 a.m. eastern.

>> several live events to tell you about. the chairman of the joint chiefs of staff speaks at the washington center on the role of the military. at noon eastern a discussion of water conflicts in the developing world. we will be live from the national archives of 7:00 p.m. eastern for a discussion of president nixon's meeting with the elvis presley in 1970. the photo of the two together is the most requested from the archives. >> now available, c-span's book, "abraham lincoln," are great read for any history buff. it is a unique perspective on lincoln from scholars and journalists and writers on his early years to his relevance

today. in hard cover and your favorite bookseller and on digital audio to listen to any time available where digital audio downloads are sold. >> next, an update on health- care negotiations on capitol hill. democratic leaders spoke with reporters for 10 minutes about their efforts to pass a bill before the president state of the union address. >> happy new year. welcome back. it is great to see you all. we just had a great meeting with all of our chairs, and i want to thank them for the important

work they have done and are doing. we are pleased our conversations continue with our counterparts in the senate at the leadership level, the committee level, and the staff level, and we are optimistic there is much we have in common in both of our bills and we will reconcile this legislation in a way that is a aaa rating richard affordability for the middle class, and accountability for the insurance company, and accessibility for many people to quality, affordable health care. i would like to yield to our distinguished majority leader. >> thank you very much. we passed a very historic health care reform bill. the senate has now passed its health care reform bill. it is necessary to reconcile these bills. there are significant differences. we will be discussing these over the next coming weeks.

we expect to move very forcefully on this effort to bring these bills together. we are very hopeful we will pass a conference report in the near term and send it to the president for his signature. teddy roosevelt started this effort almost a century ago and said we needed to make affordable quality health care available to all americans. over the ensuing century we have not accomplish that objective. we have now moved further than any time in history on a bill that does exactly what teddy roosevelt and many presidents -- republicans and democrats -- have said we needed to accomplish. we are here working on that effort. we are going to be successful. i know the president looks forward to signing a health care reform bill that provides affordability and accessibility and accountability, which the speaker spoke of.

thank you very much. >> thank you, madam speaker. i am trying to hide. i do believe that all of us have heard from our constituents over the holidays common -- holidays, and we know we look forward to having the legislation well on the way to reconciliation. we are trying to reconcile two bills better good bills. there are good things in the senate bill, great things in the house bill. what we have to do is meld these together in such a way that the american people will see it, that the time and energy in this effort has been worthwhile.

>> we are particularly delighted with the leadership of the president of the united states. without his vision and encouragement, we would not be on the verge of passing this historic legislation, and which will be placed in its rightful place alongside social security, medicare, and health care for all americans. a thing from my colleagues? >> a number of senate moderates have said the legislation cannot change much and still get the votes from the senate, so what changes is -- what changes critical? >> i am sure everybody would agree to insure an affordability for the middle class, accountability for the insurance company as it provides acceptability by lowering costs at every stage, and those are the standards we have, that i think our shared by the senate.

>> is the public auction going to be dropped? >> the public auction -- i prefer to call a the public option to increase competition. there are other ways to do that, and we look forward to the discussion, but unless we hold the insurance companies accountable, we will not have affordability for the middle class, the reforms we must have, to end discrimination on the basis of pre-existing conditions, to cap the payments and copays. it is about affordability, which is essential to accessibility. >> [inaudible] >> we will have what we need to hold the insurance companies

accountable. i contend whatever we have, we will hold them accountable, and they will be crying out for a public auction one of these days -- public auction -- option one of these days. >> [unintelligible] any response on that? >> really? there are a number of things, but there refer the letter to the assistant to the speaker. >> thank you, madam speaker. let me point out the health-care debate has been subjected to an unprecedented degree of public scrutiny and input. the original bill was put on the internet for the public to inspect. you then had a summer where you

had thousands of hearings and town meetings where people were showing up as well as telephone town hall meetings. you had all whole series of hearings -- i think it is important to note there were over 100 hearings held by the chairman of three committees who are here today. we heard from 181 witnesses. the list goes on, so we will continue to have that open process as we go through this next phase. there will obviously be discussions between the members of the house and senate, but we will continue to give the american people informed, as we have in their early stages. >> [unintelligible] >> we do not even know if there is going to be a congress permitted >> madam speaker, one of your colleagues ptomaine --

[unintelligible] how are you going to convince your members? >> i do not know what you're talking about, but i will say there has never been a more open process in any piece of legislation than people standing here have experienced. as you know, tens of thousands of people participated in our town meetings. over 100 witnesses in our bipartisan hearings that were held in the conference, and the list goes on. i am not going to repeat what he said. we now have another town venue, and that is the internet, and our legislation has had visibility for a long time in that place. i do not know who you are talking about, but what i will say is i completely disagree. we do not know what route we will take. we will take the route the does the job for the american people, that if this done in a timely

fashion in a city where the special interests are so entrenched and would like any avenue to stop this legislation. we will do whatever is necessary to pass this bill for affordable, accessible legislation but holds the insurance companies accountable. we will do it when we are ready. >> [inaudible] >> we will see what that is. we think we have the fairest approach in our bill. i always say when it comes to tax policy around here, it is like a mirror. the senate thinks there's is fairer. we will see which mirror clients -- cracks. we will do it in a way that is affordable to the american people. >> whatever the funding mechanism, the president, me, and the senate have pledged this

will be paid for. it will bring down costs, and it will bring down the deficit. >> how will we know in the process, i understand if we toasted online. -- posted online. what kind of mechanism? how will we know? >> my experience has been you know before i know, and i presume that will continue to be the process. thank you very much. but no discussion of long-term care services hosted by the journal health affairs. the forum include a look of a provision in the senate health bill that will create a long- term insurance program for the elderly and disabled. this is two hours.

>> good morning, and welcome to this health affairs briefing on our new january 2010 issue, advancing long-term services and support. this is a special day for us. we are very excited about this issue, which is the first full issue of the journal that has ever been devoted to this particular topic of long-term services. the we are extremely grateful to the foundation which provided us with the funding to execute it. as many of you are well aware,

key provisions in the house and senate versions of health care reform pertain to this area of support, the largest one being the provision of the communique , the class act. we will be hearing from one of the key people who made sure the class act was part of health reform. there are other provisions in the hill the pertain to long term support and services. we will hear more about those today, and the fact this is the case, that health reform will also include long-term care reform is an achievement not to be understated. as our issues of justice, there's a lot of reforming left to do, and there will be even if a class act and other provisions are enacted. whether the goal is events in the quality of care of long-

term services and supports or providing the most appropriate kind of care in the most appropriate setting for providing the most appropriate care for those nearing the end of life for recruiting and paying a top class long term services and support work force for figuring out how to spread the burden of the costs of all those, all those questions will remain with us, and there will remain a lot of work to be done. papers in this issue topple all of the sentence and lay out an agenda for those in the long term care sector as well as for those in government as to how best to proceed. as i have stated, we are very excited about all of this. today marks the debut of the new redesigned of affairs. we have this new redesign and a format for the physical condition of the journal.

we also have the early prototype of our redesigned web site, which will be unfolding in its crater cori later this year. we also converted from bimonthly to monthly publications of the hard copy. we have a new logo. we even have a new motto. we are now at the intersection of health care and health policy. we hope you will take a copy of the redesign journal with you and see for yourself, we have been able to execute. we think you'll find it much more readable, visually interesting, and much more user- friendly than ever before. it maintains the core of the old concept health affairs.

i want to introduce you and say thank you to the health affairs staff who are here today, all of whom worked hard to execute the new journal. will you all please stand up and take about? [applause] -- take a bow? [applause] some of them are actually out in the hall is still working to get this show on the road this morning. i also want to say things in particular to donna abraham who is the lead editor on this issue. thank you very much. i went to thank mary of the university of pennsylvania who be speaking later today for serving as are out urging our

outside adviser. i want to say thanks to barry wheeler who helped to engineer the publication of this issue without whom we would not be here. thank you very much. i want to thank the foundation once again for making this issue possible. i am going to introduce to you the ceo of that foundation. he will make some brief remarks. he comes to us from california. that is where the foundation is headquartered. the mission is to advance the development of a sustainable continuum of care for seniors. it is the second largest foundation in the u.s. focused entirely on improving the quality of health and lives for seniors. before hand, he served as the director and chief medical officer for the los angeles

county department of health services. that is after serving for the department's senior all medical director. in earlier he had served as the regional medical director for california health programs for the largest network models that were planned. previously, he worked as an academic internist. if he is currently adjunct professor of medical at ucla. he served as founding jury of ucla's five-year program. please took me in welcoming him. >> good morning. it is a pleasure to be here. let me first say we are thrilled to see this issue arrived today. it is great to see all of you here. this is a very important in

defining moment in how we think about health care and the care of seniors. i want to just begin by thanking susan, her entire team for bringing this issue to fruition. when we had this idea a little more than a year ago, we came to the conclusion that we had this nutty idea. we think you should do a clean issue of long-term services to support it. it does not seem to be a topic that you guys have covered in a long time. it is not one that you covered in a robust way. from the very first conversation, susan and the team said this is a great topic. it is time. it is something we should give more attention to. we are here today to really celebrate bringing together the leadership that could to give this issue. susan, thank you very much. i want to take the authors and the folks who have helped on the

editorial side. many are here today. you all have done a terrific job. many of you have worked on these topics for many years. we are just thrilled to see help of verot create a vehicle and opportunity to bring together your thinking in a comprehensive way. we if you look and at the things contained in both the house and senate versions of health care reform, this is not just the bill about standard health care reform, and if you think about where we started out, it will be about coverage regan -- about

coverage. it will be about access. you look at the bill carefully, the foundation of comprehensive and longer-term service support in this bill. when you look at things like creating an office for the center of innovation. if you look at the proposals, if you did get the ideas around improving home businesses that the state level taken as a whole, long term services starts with what is in this bill. the stars of health care reform. if one really cares about things like improving quality, creating more care, creating a quality of life and not as tough agenda, and the really important decisions like and in the cost curve -- it is for those who use

the system. it is for those most in need for those opportunities. we think that today's issue and the comments that will be made by i by our officers will really be here today. thank you very much. [applause] >> as bruce mentioned, several authors are also with us today who will not be presenting. it is only because we cannot have a news briefing that was three or four days long. we did not include all the others in this issue. i do want to say a special word of thanks to don taylor of the duke, diane meyer of mount sign a, and all who contribute to the issue. they were healthy to have as with them. long-term care and health care are long-term issues. there also a deeply local and personal issues.

we also talked of a national perspective. we want to be conscious that help affairs is very much a local issue. we are very happy to have with us this morning from the d.c. city council, an independent council member of the d.c. council. he was elected in 1997. he headed the committee on health care for the council. he is also a member of various other council committees including the committee on government operations and the environment. we asked him to come today particularly because he has led dc's effort to make enormous and often ensung inroads into the insurance problem here in washington, d.c. he has begun to take on the long-term services and supports issue.

people from washington are as much a citizen of the country as anybody else and a deeply affected by these issues. let me briefly welcome to the podium to make some remarks from a local perspective, councilman catania. >> good morning, everyone. thank you, susan, for that introduction. this is an issue that is incredibly important to the district of columbia. yet 19 skilled nursing facilities. we have twice as many cmf did deficiencies at the national average. three homes are rate among the worst in the country. this is an area that has long been ignored in the city. we just sent only the quality of care. do you measure quality? how you define efficiencies?

a few components we are working on in kansas is a requirement for physician services on the premises. we found [unintelligible] we have found that the first thing that our skilled nursing facilities do is called 9-1-1. 20% if you live in the district, 20% of our pms calls in the city are to our 19 skilled nursing facilities. the average more than one a day. a few of the reforms we are seeking is a physician present at a minimum of 40 hours per week. we are looking at increasing the nurse staffing ratio per patient per day. we are requiring expand its

services on our side that include everything from a tie tree to dialysis. -- from podiatry to dialysis. we are making a huge investment in community based care. we have tripled the number of placement of our elderly persons with disabilities labor. we have invested more heavily in any jurisdiction in the country with community-based care. we have to make sure we reconnect our center with patients who are in nursing homes and has seen people checking in and not checking out without aggressive front end. we are requiring within 72 hours of its mission a conference of help analysis. there'll be discharge planning under way to make sure that if the patient need to be there

they will be there. if they do not need to be there, we will connect them with our epd waiver. we are looking at being very pro active in making sure that our nursing homes have no way out. if you are in the long term care business, we pay you a hefty wage to take care of our residents. it will no longer be standard operating procedure as a privilege. with restraint in not only our use of restrictive licenses, but strengthening our petition for receivership so we can actually assume control if we are not satisfied in the way we are operating. a few other items. we are going to be eliminating the use of restraints in the district. we are strengthening family councils and forcing a greater care.

we are increasing the standards for our nursing home administrators. we will test competency to make sure you finally, something that is very important to me -- improving the way in which our community is treated in the long term care capacity. many individuals in this community are forced to go into the closet as they go into long- term care company said there is sensitivity training for our employees. these are a few of our items. so the firm barre had the great privilege of reading boxes of every -- jennifer had a great privilege of reading boxes of every policy in nursing homes. we saw some that had good procedure. we saw some did not follow them.

we will take every opportunity to be the best provider from skilled nursing to long-term acute care, and we have started those first steps. you. >> as we can see, much remains to be done on why our issue is so well times. we will begin our first panel which is an overview panel on you is getting and delivering care. some of our audience are encountering these issues for the very first time. we sat -- we strive to set the context. we are going to try to do it today as well. i will introduce our three panelists for our first panel.

and then they will get up and presented their remarks. you also have copies of their slides in your packet. we will hear from stephen kay, an adjunct professor at the institute for health and aging and the department of behavioral sciences at the university california's san francisco. he served as co principal investigator at the center for personal assistance services, which is a rehabilitation training center funded by the national institute on disability. he is also co-director of the university of california at san francisco's disabilities to cystic center and a co principal investigator of the specific ada center. he is a ph.d. -- ph.d. from stanford. we will then hear from carol levine who is with the united

hospital fund in new york city. she directs the family health care project which focuses on developing partnerships between health care professionals and family caregivers. she directed the citizens commission on aids in new york city previously. she was senior staff associate of the hastings center. in 1993, she was awarded the fellowships for her work in aids policy. she edited a book called "always on call." she also co edited a book called "the cultures of caregiving." she has a personal experience with being a family caregiver, having cared for her brain injured husband for a number of years before his death. we will then hear from robyn stone, and the executive director for the center of aging

services. since she started the institute 10 years ago, she is developed a number of national programs including the center for medicare education, the better jobs better care of national program. she was a political appointee during the clinton administration, serving in the department of health and human services. she also was assistant secretary for aging in 1997. she is been a senior researcher for health services research and project hope center for health affairs previously. to begin, but welcome to the podium.

let's welcome him to the podium. >> people tend to view long-term care through a particular lands, depending on what they are interested in. some people focus on specific federal programs. they might focus on quality issues or workforce issues. they also tend to focus on specific populations of elderly. as carol levine said in her article, the whole is often eclipsed by a separate part. this article is an attempt to paint a picture of that hole, although i realize there are plenty of my own biases in it. we include people receiving

long-term care from public programs, from family members, from private paid workers, whether they live in the community or institutions, whether they are elderly or of not elderly, whether they are nearing the end of their lives or perhaps have a stable and live on disability. to do that we analyze data from five national surveys conducted by various federal agencies. for details, see the article which you have that is written -- which was funded by the national institute for research. how many people need long-term care services? that depends on how you define the long term care population. it can arrange all the way up to 11 million people if you include people need help with

any kind of routine daily activities. . . often quite a bit larger than the institutional population, which is between 1.5 million n 1.8 million people. who are these people who need long-term service? it is well known that when men dominate, especially in institutes -- that women dominate, especially in institutes. the long-term care population is not elderly. despite the fact that the vast majority of people living in institutions are elderly.

over half of the long term care population does not elderly, even if you define it narrowly. half of those live near or in poverty. who provide services to people who live in the community? as you would expect, a person's primary source considers -- varies with their age. parents dominate for adolescents and young adults. by age 30, the spouse becomes the dominant helper, followed by a daughter or a son. more often a daughter and then a son. that holds true until age 75 trade at age 75 spouses start to

decline and daughters and sons take their places. only by age 85 do paid helpers are really come into play. as you can see from this chart, and paid helpers' dominate for people of all ages. 9 tons of people needing help -- 9/10's people needing help get it this way. who pays for long-term care services? that depends on the setting. on the institutional side, medicaid dominates as the pair. usually with a substantial copiague by the resident or his or her family's -- copay by the

resident or his or her family's. for others, the resident pays all or most of the bill, which is typically $5,000 a month. medicaid is not a major player on the institutional side except for early in the nursing-home stage. on the non-institutional side, things are different. you may find it surprising that medicare and medicaid are nearly equal as the players. medicare pays for home health services after a hospital discharge. that sense of being a lot of the it services in the community. often it is the person and his or her family that pays primarily for services. this pays typically last, at $250 per month. if people save money when they

are hiring workers themselves by hiring an independent provider which not only saves them money, but gives them more consumer control in contrast to government agencies, nearly always use an agency providers. oops. how much does it cost. in terms of medians, there is a factor of five, the difference between the two. about $5,000 per month for non- institutional care services. the indians cannot tell the whole story. on this -- medians do not tell the whole story. this shows that base and long- term health services are almost always less expensive than nursing-home services. nursing-home services hardly ever cost less than $3,500 per

month. 87% of non-institutional long- term care services cost less than $3,500 a month. these are two very different populations. they are very different populations, but not as different as you think. the average number of daily activities that people need help with is 3.5, compared to 3.9 for people living in institutions. there are a lot of people with rather severe disabilities in both groups. 40% on the institutional side need help with five or more activities of daily living. they are different, but not as different as you think, and yet you have this factor of 5 ratio and cost. in terms of national expenditures, we are getting an

estimate of $147 billion per year and national expenditures. you can add or subtract $20 billion depending on what you want to count as long-term care verses non. more than three-quarters of that expenditure is for institutional services, even though, as you recall, institutional services are a minority of the long term care population. 80% of those expenditures go to elderly people. half of the long-term care population are elderly and half are non-elderly. before we conclude, i think this chart shows fairly clearly what we have a long-term care system that is out of balance. most are services that people do not want.

the services that people do want are often tightly rationed. i think it will be fairly hard to justify the five to one cost ratio when we find that the populations are not that different. we feel that the emphasis on institutional services for the elderly may end up the nine non- elderly people that need long term services their share of the long-term budget. we also think that there is evidence that most people do not seem to use paid help when they have an alternative. people cannot use paid help as a secondary helper. that turns out to be very rare. we wonder whether these considerations over the woodwork and fact -- effect, we feel that

these may be exaggerated. [applause] @@@@@@@@@ @ @ @ @ @ @ @ @ @ @ @ ella of the health of sir staff is working so hard on this special issue -- all of the health affairs staff is working so hard on this special issue. i also want to acknowledge david gould of the united hospital fund. he set the stage very well for this. nearly every discussion of long term care and support starts with the statement that family

and friends are the system's back bone. like bedrock, family caregivers, that is a term that we prefer to informal. informal sound so casual, so easy, so much fun. bedrock is underground. bedrock is invisible. when you start to see it, you may be a little bit nervous. that is what is happening in the policy world. we are starting to see these underground workers that are starting to appear and make some demands. families have always played an important role in caring for people that are sick or aging. in the past two decades, family caregiver roles have changed. in addition to funding social support, many are now taking on

demanding managerial tasks. managerial tasks are just as hard, if not harder than the actual direct provision of care. family caregivers as a large group are very diverse. some provide a little bit of care, some provide a lot of care. my colleagues are focusing on this. people with multiple chronic illnesses, multiple medications to manage, frequent hospitalizations, high-cost. at the end of the day, for these caregivers, there is no end of the day. the institute of medicine recognizes in its 2008 report, when it recommended that the definition of the work force be expanded to include family and friends, it also noted that it was not clear how to integrate

family into health care practices. one of the purposes of our paper and the campaign which i direct is to demonstrate that it can be done and give examples of how it is being done. there are models out there. let's try this. i am going back. i am sorry. do you want to get me back to where i was? sorry. next one. go back. one back. sorry. thank you. family caregivers confront fragmented systems. fragmentation exists within the system and even more between systems. providers work mainly in one silo or a sub-silo or sub-sub-

silo. caregivers move frequently between their rapid frequent transfers to acute, to sub- acute it to the family settings. we heard that this morning. home and community-based services are sometimes described as a patchwork of different programs with different eligibility rules. a patchwork suggests individual pieces sewn together to make a whole. community care is often the patches without the connecting thread. to navigate this complicated and still incomplete system come up family caregivers are to provide continuity as advocates and quality sentinels for people who cannot manage on their own. transitional care to next healthcare and long-term

services at a critical moment for quality, cost, and outcomes. there are no discharges in transitional care. the handoff is not completed until the patient is under the care of the family caregiver. there are several models like can be shown. this includes a website, www.nextstepincare.org that is designed to improve relations between hospitals. if it is also organizing an event in new york city in which 40-50 providers will work in partnership to improve the transition and care from our collaborative design group, six months working with 14

providers. our biggest learning was getting people to prevent sending patients back and forth four years. they never talked to them about the process these. they talked about the locations, but not the process these. -- processes. the transitional care model is one of them at the university of colorado. andy care program at johns hopkins. there are others out there as well. our article concludes with some recommendations. we want to encourage and develop information about caregivers, not just in their psychosocial state and what they do, but how they interact with

the health-care system and the social services and how those things could be improved by bringing them together. we believe that working with family caregivers in this current and future environment house to be a core competency for all health care and social service professionals. this is not something that is intuitive and can be caught and -- can be taught and can be learned. we want full integration of family caregivers and medical homes and transitional care programs, and not just by name only, but by explicit attention to what the family caregivers need. we want to encourage creation of payment schemes which includes the support. policymakers are often moved by family caregivers valuable stories. the story is supported by the

practitioners must be translated into specific policy actions which are family caregivers. the health-care provider and policy-makers and join forces with their combined efforts and can be a positive force for better coordination and integration of all of the elements of long-term care services. [applause] >> good morning, everybody. but also want to thank susan at health affairs, bruce chernof, and all of us collectively for putting together a fabulous volume. it is pretty cool to have the

first long-term care services. i said that this was a bastard child and now we are in the forefront. quite only have a few minutes to talk about, what i think it's a very important issue, probably the most important issue in all of this. if i start with the caveat that the article that i did with mary, to husband around for a long time, we focus primarily on the providers providing services to older adults. that is not to say that there are not other substantial issues for the provider community for persons under the age of 65. most of our work has been done in the area of caring for the

elderly. the literature is much stronger in the caring for older adults. there is work and needs to be done caring for the younger populations. i wanted to start with one other comment. that is come up who provides long-term care in many ways it depends on your definition of long-term care. we will never reach a consensus on this. what we have recognized is that the long-term care, -- a term services and support, formal service sector is somewhat unique, but embedded in the larger health-care sector. somehow, we have to struggle and figure out how to get a enough attention in that part of the service sector that it begins to

get parity, not only with other industries, but with the larger health-care sector itself. i will talk about that in a minute. it is important to understand that medicare may not cover a lot of long-term care, but it covers a lot of post acute-care. sometimes we talk about it as long-term, sometimes we talk about it as acute. whether we want to talk about it as long-term care or not, it is the long-term care providers that frequently have to deal with these issues. next in the family, they are the folks that are embedded in this mess of service providers across the acute, primary, sub-acute, primary, and long-term care sectors. they are really key, next to the family, and holding this

fragmented system together. in the long term care sector as opposed to the acute, and primary, and ambulatory care sector, they are primarily the hands-on care system next to the family. at least 70% of all services are provided by your front line. in your personal care workers. this is different than the acute-care and the primary care world. we have a much heavier a bubble of professional staff. the professional license staff, while fewer, have substantial managerial, clinical oversight and hard-core clinical and support of work that they have to do. these are the medical directors, the lpn's your licensed social workers, and the administrators. as you heard, where i live, the

problem with the d.c. nursing- home is, it is the people, stupid. it is the people in these institutions. they have not been given the support, training, the ongoing support to do their work well. it is difficult to ask for quality when you have not supported the work force to do the job. it is a very labour-intensive field. one of the most labour intensive next to hotel industries. to not invest in our workforce and talk about a panacea of quality, comes without warp -- worrying about what people do every day is a mistake. we try to make the case that this is where much of the investment needs to be. this lays out a framework for assessing work force reform in the context of long-term care

specifically. with the caveat that long-term care blurs with acute care, chronic care, preventive care. it is difficult to pull those out. we have to look beyond traditional supply and demand theory. they do not work. we have a lot of demand for services. we are going to see a lot more that has not translated into more money, more investment, and the supply and demand. does not work in long-term care. a lot unlike other parts of the health sector, almost all of our pay comes from medicaid and medicare, so we are dependent on the public payers. what they pay is what we get. that is not the way traditional supply and demand works.