Publications on Long-Term Care

As the nation grows older, it's time to find a better way to care for those who need help as they age. The financial, emotional, and physical costs of providing long-term care often overwhelm families. Unpaid family members supply most of it, struggling to balance these duties with work and other responsibilities. A year's stay in a nursing home averaged $78,000 in 2007, and public assistance is not generally available until residents have exhausted almost all of their financial resources. Policymakers should encourage Americans to prepare for their own long-term care needs or create a larger role for government financing

A longitudinal survey of parents of enrollees in the Los Angeles Healthy Kids Program has found that the program had significant positive impacts on children’s health and access to care. Children experienced improvements in access to and use of ambulatory, specialty and dental care; reduced unmet need; increased parent confidence in getting care and satisfaction with quality; and reduced financial worries. Most important, children’s health status improved, as perceived by parents and according to several measures. Healthy Kids covers uninsured children below 300 percent of poverty who are ineligible for Medicaid or SCHIP, and primarily serves poor, undocumented Latino children.

Panelists discussed the needs of the frail elderly and homeless populations, the missing pieces in housing options, design solutions that can improve accommodations, and ways to better a delivery system that is highly fragmented across jurisdictions and target populations.

This paper proposes to expand Medicare to cover comprehensive long-term care services, including home care and custodial nursing home care. These services would be financed by a surcharge on federal income taxes. Unlike the regressive payroll tax that finances Medicare’s hospitalization coverage, the proposed surcharge would not increase tax burdens for low-income people. Beneficiaries would share costs through deductibles and copayments, but the program would include stop loss coverage and special protections for low-income adults. By providing long-term care insurance that protects the assets of older adults, our proposal would eliminate the savings disincentives inherent in the means-tested Medicaid system.

Working without pay and often putting in long hours over many months or years, family caregivers improve the lives of many frail older Americans. The help they provide saves the public billions of dollars a year in nursing home and paid home care costs. Yet care responsibilities often create serious burdens for caregivers, especially those balancing elder care duties with paid employment and childcare. More public funds are needed to support their work.