“Finding a way to better finance long-term services and supports (LTSS) is high on the list of the nation’s health policy and political challenges, even though it is not high on today’s political agenda. Current policy underserves people who need care, overburdens families who care for them, and strains state budgets supporting Medicaid services when personal resources fall short. These already significant shortcomings will only increase as the population ages and more people need care.
“The fundamental LTSS financing problem is the absence of an effective accessible insurance mechanism to protect people against the costs of extensive LTSS they may require over the course of their lives, which often far exceed most people’s ability to pay. LTSS presents exactly the kind of unpredictable, potentially catastrophic risk and expense, with a high degree of variability, that insurance is designed to address. Most people now turning age 65 cannot know in advance whether they will be among the roughly half of their age cohort who are expected to die without suffering significant levels of impairment – that is, having two or more limitations in Activities of Daily Living (ADLs) or having severe cognitive impairment – or be among the 12 percent expected to need more than five years of substantial care.1 When LTSS needs last for at least two years, average LTSS spending is about five times higher than for older people whose LTSS needs do not last that long. Most of the nation’s LTSS costs are incurred by people with long-lasting needs.2”
Source: Marc Cohen, PhD, Judith Feder, PhD, and Melissa Favreault, PhD. A New Public-Private Partnership: Catastrophic Public and Front-End Private LTC Insurance. January 2018.
“The proportion of the US population over 65 years old is increasing dramatically, and the group over 85 years old, the “oldest old,” is the most rapidly growing segment. People who survive into higher ages in America, which itself is an aging society, face a suite of competing forces that will yield healthy life extension for some and life extension accompanied by notable increases in frailty and disability for many. We spend more, for worse outcomes, than many if not all other developed countries, including care for older persons. Looking forward, our health care system is unprepared to provide the medical and support services needed for previously unimagined numbers of sick older persons, and we are not investing in keeping people healthy into their highest ages.”
Source: Rowe, J. W., L. Berkman, L. Fried, T. Fulmer, J. Jackson, M. Naylor, W. Novelli, J. Olshansky, and R. Stone. 2016. Preparing for Better Health and Health Care for an Aging Population: A Vital Direction for Health and Health Care. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. doi: 10.31478/201609n
“Changing family structures and shifting roles for women in the United States population will also have significant effects on the supply of LTSS. Informal caregivers are an essential provider of uncompensated LTSS. In 2009, informal caregivers, typically women, provided up to three-quarters of these services, amounting to an estimated $450 billion in unpaid care (Feinberg, Reinhard, Houser & Choula, 2011). Along with the growth of the population age 65 and older, however, is the likely decrease in the availability of the population that typically fills the role of informal caregivers. Transformations in societal norms, such as more women working full time, decreasing birth rates and smaller family size, and an increase in the number of people who never marry, contribute to additional gaps in the supply of informal care. In addition, informal caregivers are increasingly tasked with more complex and demanding care activities, such as medication management, wound care, and incontinence care, yet they often do not have adequate support or training (Thomas & Applebaum, 2015).”
Source: Nga T. Thach, BS, and Joshua M. Wiener, PhD. An Overview of Long-Term Services and Supports and Medicaid: Final Report. RTI International for the US Dept. of Health and Human Services. May 2018.