A cottage industry of writers and analysts is now blossoming around THE question of the day: How has the COVID-19 pandemic permanently changed our lives?
Much attention, of course, has focused on jobs and the economy. But we are also beginning a long-overdue conversation on another area that the pandemic exposed as terribly inadequate. That area is long-term care — a critical need that can define the quality of life for any one of us and will be increasingly sought after in the coming years.
The system needs an overhaul. President Biden has launched the conversation by including $400 billion to enhance home- and community-based services (HCBS) in his infrastructure plan. This creates an opportunity for a bipartisan debate and work on a major policy issue that calls out for leadership on both sides of the aisle.
Families in search of long-term care enter a world that is fragmented, confusing, costly, under-regulated and lacking in transparency. Too often, individuals and their loved ones must desperately cobble together a patchwork of ways to get the services they need.
Surveys tell us that people usually do not plan for the cost. Many lack knowledge about long-term care insurance (which may provide only limited protection). Folks who end up in nursing homes often yearn to live in more intimate, less institutional environments. Wherever individuals get care, they depend on low-paid workers with little chance of career advancement.
A national conversation on long-term care should focus on innovations to enhance choice, quality and affordability. It can highlight ways to make care safer and ensure that it is available to all, including underserved population groups who bear the greatest risk of death and disability. Importantly, we should consider ways to strengthen the paid long-term care workforce, while also doing more to support unpaid family caregivers.
The care problem is bigger than COVID-19
The pandemic shows how badly we need this conversation.
Nursing homes and other long-term care facilities have accounted for more COVID-19 deaths than any other category — about one-third of all U.S. fatalities, totaling more than 183,000 residents and staff even though less than one percent of Americans live in nursing homes. These numbers are a national disgrace. And they reflect more than the pandemic alone. They are a consequence of deep, structural flaws in our nation's approach to care.
Sadly, reports in the media rarely explore these underlying defects. Left unfixed, they will lead to a personal care crisis for more and more families. With a growing aging population, demographics guarantee it.
Already, over 10,000 Americans turn 65 every day, a group that will represent more than 20 percent of the population in the coming years. According to government data, someone turning 65 today has almost a 70 percent chance of needing long-term care at some point, often for an average of three years. Cases of Alzheimer's, Parkinson's, cancer, heart disease and other chronic health conditions will inevitably increase as more Americans live into their 80s and beyond. Disabilities are significantly more likely among older people — about a quarter of those age 65 to 74 and half of those 75 and older live with a disability, accounting for over 17 million Americans.