Perspective: Five Actions to Address the Crisis in Long-Term Care Services and Supports 

The eldercare crisis is among the top policy challenges facing the nation, yet the scope of the response to the crisis continues to fall short, even though the health and well-being of millions of Americans are at stake. What can states and their partners do to change this?

Dr. Joanne Lynn, a gerontologist and expert on eldercare policy at Altarum, writes in the latest issue of the Journal of the American Geriatrics Society, an open access publication, about five actions that are needed to ensure the growing number of elders and their caregivers will get the support they need in the coming decades. Some of these actions can be taken by states, and Altarum is working closely with them on these issues.

But first, how did we get to this point? Factors contributing to the eldercare crisis are chiefly demographic and economic. The population of elders over 80 will increase 79 percent between 2010 and 2030, while the population of people at the peak age of caregiving (45-64) will increase by only 1 percent over the same period.

In addition, most people are entering retirement without the savings needed to cover the cost of long-term care. In 2014, the median person entering retirement had only $15,000 in savings, and an increasing number of retirees have mortgage debt, and fewer have the pensions that the previous generation relied upon for financial security in old age, writes Lynn.

Lastly, there are not enough paid caregivers to meet the growing demand for their services. And while demand for caregivers is high, their pay remains stubbornly low, making it difficult to build a skilled and stable workforce of caregivers.

Lynn notes that we cannot simply raise taxes and count on Medicaid—in its current form—to address this problem. Instead, we must take five specific actions.

Five Actions to Address the Crisis in Long-Term Care Services and Supports (LTSS)

• Incentivize personal saving for retirement, LTSS insurance, and long-term care
• Develop “front-end” coverage at the start of a long-term illness or decline 
• Invest in the work-readiness of young people so that the economy is strong, and can yield more tax revenue
• Standardize and improve the quality of geriatric medical care 
• Enable communities to drive down the per capita cost of disability in old age, and improve reliability and appropriateness of services through local innovation and collaboration

How Altarum is Working with States on Long-Term Care

The last two points are particularly relevant to states—improving quality of long-term care and working with communities to drive needed long-term care transformation. Altarum is working with states on a variety of such initiatives, including the following:

• helping to build a national volunteer caregiver corps;
• working with health systems, payers, and provider practices to leverage health IT, continuing health care education, and care coordination to improve quality and standardize service delivery; 
• working with communities to expand existing programs such as PACE, the Program of All-Inclusive Care for the Elderly, so more older adults can benefit from its services; and 
• supporting and evaluating a culture change initiative at six nursing homes in Michigan to help them adopt more person-centered services and practices.

Learn more about our long-term care quality improvement services by contacting Anya Day, Director of the Center for Appropriate Care. And read Dr. Lynn’s full article “The ‘Fierce Urgency of Now’: Geriatrics Professionals Speaking up for Older Adult Care in the United States”.