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The Candidates Need to Talk About Long-Term Care

Why this issue deserves their attention — and yours

By National Council on Aging | August 27, 2014

While reform of the health system has been a central issue in the 2012 presidential election, see if you can find the candidates’ positions on long-term care.

The lack of attention is alarming. Every day, millions of American families struggle with providing long-term care for themselves or a loved one.

Long-term care includes a broad range of assistance with everyday activities, such as dressing, bathing, using the bathroom, preparing meals, taking medication and managing a home. Access to these services and supports allows individuals to age with dignity and independence.  

This is a major national issue in need of bold thinking, debate and solutions. Not talking about it won’t make it go away.

Here are eight reasons why the candidates should be talking about this issue:

1. The need is now. About 12 million Americans with disabilities need long-term services and supports, nearly half of them under 65 years old.

2. The need is growing. As the U.S. population ages, the number of individuals who need long-term care is projected to double to 27 million by 2050. More than 70 percent of Americans who reach age 65 will require some form of long-term care in their lives.

3. Most Americans are not prepared for the high costs of long-term care. Medicare doesn’t cover it, and less than 10 percent of Americans have private long-term care insurance. This kind of insurance is unaffordable for many Americans and unavailable to most individuals with disabilities, because of underwriting practices.

4. Federal and state funding is dwindling. Medicaid is the primary funding stream for long-term care, financing about 62 percent of total spending. But it requires individuals to impoverish themselves to receive the services they need. And as a result of the economic downturn, some states are cutting Medicaid services.

5. Nursing homes are not the answer. The vast majority of Americans want to receive care at home. Yet there remains a strong “institutional bias” within Medicaid. The majority of funding goes to services in nursing homes and other institutions, even though home and community-based services are more cost-effective.

6. Waiting lists for Medicaid home and community-based services have doubled over the past decade. Lack of available home and community-based services denies Americans choice, independence, productivity and their rights against discrimination under the U.S. Supreme Court Olmstead decision.

7. Family caregivers are getting burned out. The vast majority of long-term care is delivered informally by more than 65.7 million family members, who often face negative impacts on their own health and ability to work, as well as financial hardships. Caregiving has economic consequences for U.S. businesses as well, including lost productivity and higher health-care costs.

8. There is a severe shortage of direct-care workers. The current direct-care workforce numbers 3 million, and an additional 1.8 million workers will be needed over the next decade to keep pace with growing demand. But home-care jobs are marred by low wages, minimal benefits, and a high level of job stress and hazards, all of which leads to high turnover.

From "8 Reasons the Presidential Candidates Should Be Talking About Long-Term Care," by the National Council on Aging.