Americans do not,
generally, plan for their own very likely future need for long-term care, and
the federal government has yet to offer a program that meets these needs for
most people. Family caregivers provide much of that care, at great cost to
them, and long-term care insurance has shown limited success in uptake, as well
as a dwindling presence in the insurance marketplace. What lies ahead for the
burgeoning population of older adults that will need long-term care?
In “America’s Long-Term Care Conundrum,” Guest
Editor Ruth Katz succinctly lays out the psychology behind not
planning for our own needs in older adulthood, especially the need for
long-term care, and describes what she learned in a listening tour of the
United States, wherein she was schooled in what happens on the ground when
people need and use long-term services and supports. Our current way of
financing LTSS is unsustainable, Medicaid is not the solution, family
caregivers are at a breaking point, and politics are standing in the way of a
solution. But there is hope in learning from how other countries have solved
their similar long-term-care quandaries.
Barbara Coulter
Edwards and Aditi P. Sen,
in their article, “High Demand and Fragmentation: The Current State of Long-Term Services and Supports in America,”
explain the current challenges to financing long-term care, especially as
people age into the frail elderly category; how increasing levels of cognitive
decline will affect long-term-care costs; workforce shortages (which may be
exacerbated by new immigration policies); and how policy makers and legislators
might approach solutions through coordinated state and federal efforts.
In “Re-imagining the Delivery of Care for Older Adults with
Chronic Conditions,” Howard Gleckman describes
how the delivery of medical treatment and social supports in the United States
is uncoordinated, and degrades the quality of life of older adults with chronic
conditions, as well as possibly adding unnecessarily to costs. But now some
public policy changes and market initiatives are resulting in the development
of new models that better integrate care. What might they look like?
Robyn I. Stone, in her article, “Financing Long-Term
Services and Supports—and the Challenge of Underlying Assumptions,” writes of
the almost 30 years’ worth of options for financing long-term care that have
been explored. Since 1990, policy makers, insurers, providers, consumer
advocates, and researchers have struggled with underlying assumptions that
affect the nature, scope, and political viability of any long-term services and
supports program: Should a program be medical or functional? Is it a
quality-of-life issue? Should such a program cover all people or just older
adults? Should participation be mandated or not? Should the program be funded
at the national or state level? The path ahead remains unclear.
“Preparing for LTC Financing Reform: How Can Racial
Disparities Be Addressed?”, by Barbara Gay, Ruth Katz,
and James H. Johnson Jr., tackles the long history of racial
discrimination that has resulted in racial disparities in long-term services
and supports. Challenges in accumulating wealth have left older African Americans
with fewer choices of services, providers, and settings for long-term care.
Specific challenges older African Americans and their families face also are
discussed, as are changes in public policy that are necessary to address racial
disparities in the long-term-care field.
Alisha Sanders, in her article, “Housing Plus Services:
A Model that Supports the ‘Whole’ Person,” explains trends indicating that
elders, many with chronic conditions and functional limitations that increase
their risk of needing expensive acute care services or of moving to a high
level of care, will be economically insecure and struggle to find or to
maintain affordable and accessible quality housing. New care delivery models
linking affordable housing settings with services offer one promising approach
for supporting such low-income older adults.
ASA is pleased to offer this latest issue
of Generations, which will reach ASA members and subscribers in
late April to mid May 2019. Single copies of the issue can also be
purchased from our website.
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