A message from Judith Feder and Sheila Burke

Policy Perspective: What about Long-Term Care?

Long-term care—assistance to people who need help with basic tasks of life, such as bathing, dressing, and preparing meals—has rarely been high on the nation’s policy agenda. And it shows.

The quality of long-term care services can be abysmal and dissatisfaction with our long-term care system is widespread. Public support emphasizes the institutions people do not want to enter rather than the care at home where people want to stay. The financial burdens of long-term care can be catastrophic and the caregiving burdens on families, overwhelming. As a result, about one in five persons living in the community with a need for assistance from others has unmet needs, endangering their health and demeaning their quality of life.

Two sources of pressure will exacerbate these problems. First is the recent recession’s threat to Medicaid. Lower revenues and more people with few resources are testing states’ abilities to sustain their Medicaid programs. Medicaid is the nation’s long-term care safety net, providing last-resort support both in nursing homes and, increasingly, at home. The second source of pressure is the aging of the baby boom generation. Although a significant number of people under age 65 need long-term care, the risk increases with age. A nation with many more elderly people will almost certainly face greater demands for long-term care.

Despite these concerns, long-term care is not on the public policy agenda. It’s time to recognize that long-term care is a serious risk that deserves serious policy attention.

Judith Feder and Sheila Burke are co-directors of the Georgetown University Long-Term Care Financing Project. Support for this project is provided by the Robert Wood Johnson Foundation.