The Future of Long-Term Care: What Is Its Place in the Health Reform Debate? – US

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More than 10 million
Americans require long-term care supports and services. Yet the system for delivering
and paying for this assistance is deeply flawed.

While most of the frail
elderly and those with disabilities prefer assistance at home, many must live
in nursing homes to receive Medicaid benefits, care coordination for those with
multiple chronic illnesses is poor, and the system for financing care impoverishes
many middle-income families. The national health reform debate allows policymakers
to reconsider long-term care as well. This paper assesses proposals to restructure
the delivery and financing of long-term care services.
Introduction

As the population ages, demand for long-term care supports and
services is growing. Today, 10 million frail elderly and adults with disabilities
require such care. Nearly 80 percent is provided at home, much of it by family
members and friends. In 2007, the cost of paid services was estimated at $230
billion, while the economic value of informal care may have approached $375
billion. As the Baby Boomers age, both demand for this care and its costs are
expected to increase dramatically.

Today, most paid care is funded by government, through Medicaid
and other programs. Less than 10 percent is financed by private long-term care
insurance, and much of the rest is paid for out-of-pocket by families themselves.

Despite the considerable resources devoted to long-term services,
many continue to receive poor quality care. As a result, policymakers are pursuing
major changes in the way assistance is both delivered and financed.

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