Long-Term Care

Each summer, NASI’s Somers Aging and Long-Term Care Research Internship program selects 5-7 graduate students to spend 12 weeks receiving high-quality training in policy research skills on challenging issues facing the diverse aging population of the United States.

The Co-chairs of the President’s Commission presented a number of policy proposals aimed primarily at reducing the growth spending on Medicare and Medicaid. Given the size of the two programs, some of these changes may impact health care spending patterns in the private economy, but many will simply shift costs to other payers. Few, if any, proposals would address the underlying growing demand for services triggered by an aging population and a long term care system that relies on private savings.

The United States is going to try something new – a social insurance approach to the problem of paying for long-term services and supports. As more and more of the 76 million baby boomers move into their 60s and beyond, there will be a growing population of people who need help with the activities of daily living (using the toilet, dressing, bathing, eating, getting in and out of bed, walking around in the house or apartment). To date, this has been a private responsibility, with individuals and families providing care or paying for it out of their own funds. The government gets involved only if you go into a nursing home and “spend down,” using all your money until you have just $2,000. Then you qualify for Medicaid, the government’s health program for the poor.

Often left behind instead of going to the dance, long term care may finally see its opening in health care reform. Until now, few reform proposals bothered with long term care (LTC) in spite of the fact that a much greater share of the population is at risk compared with the scope of the “uninsured” for general health care. In addition, social insurance advocates and private insurance supporters often were in an uneasy alliance around how to approach any LTC reform, further hindering chances to address it. But with the reform of health care likely this year, LTC supporters have, for the most part, coalesced around Senator Kennedy’s CLASS Act as the most likely ticket to the dance.

Informal care provided by family members improves quality of life for frail elders, allows them to remain in the community instead of in nursing homes, and saves Medicaid dollars. Providing the care also imposes opportunity costs on caregivers that weaken their own retirement security. Retirement Security for Family Elder Care Givers with Labor Force Employment proposes to provide up to four years of Social Security credit to individuals who provide care to elders. The elders must be certified to need levels of care that would qualify for Medicaid coverage. The value of the credit would be the caregiver’s average wage in the three years before care giving interrupted earnings. The authors suggest the credit could be financed based on the reduction in public spending for nursing home care.