Major Reforms for US Long-Term Care System Recommended

Reforms are needed to expand access to long-term services and supports (LTSS) for people of all incomes because the current system of financing LTSS is inadequate, especially for those with high levels of need, according to a report from the Long-Term Care Financing Collaborative.

The Collaborative’s report, “A Consensus Framework for Long-Term Care Financing Reform,” noted that the current system of long-term care puts an enormous burden on family members and friends, often results in poor care, and frequently causes preventable harm that endangers recipients of care and their caregivers, and increases medical costs.

There are currently more than 6 million older adults in the United States that need a high level of care, and this number is expected to increase to nearly 16 million within 50 years. The report proposed major changes in the way long-term care is financed and delivered in the United States, and claimed a broad package of reforms are needed in the form of both public and private initiatives.

“No voluntary insurance program is broadly affordable,” according to the report. “Thus we recommend a universal catastrophic insurance program. One benefit of such a program is that it is likely to significantly reduce Medicaid’s LTSS expenditures for older adults.”

The Collaborative’s July 2015 report on financing recommended ways to better support families and communities that provide LTSS, proposing better integration of LTSS and medical care, greater support for paid caregivers and families, and enhanced support for communities and employers of caregivers.

In the most recent report, the Collaborative recommended:

• A universal catastrophic insurance program aimed at providing financial support to those with high levels of care needs over a long period of time.
• A series of private-sector initiatives and public policies aimed at revitalizing the long-term care insurance market to help address noncatastrophic LTSS risk.
• Encouragement of retirement savings and development of more innovative use of home equity to assist middle-and-upper-income families finance LTSS needs for risks not covered by catastrophic insurance.
• A modernized Medicaid LTSS safety net for those with limited lifetime incomes and those who deplete assets paying for medical and long-term care.
• Stronger support for families and communities that are the bedrock for people getting care at home, and better integration of medical treatment and personal assistance.

There is no single solution, the report concluded.

“…we believe that any reform must also serve the needs of younger people with disabilities,” the authors wrote. “We also believe transitions between insurance and safety-net programs must be seamless and must not leave middle-income people without access to either.”