As the coronavirus pandemic’s most catastrophic effects recede in nursing homes and other long-term care facilities, notably due to vaccinations and other public health measures, residents and their loved ones still face costly, confounding issues in safeguarding the aged, sick, and injured. The Biden Administration wants to spend hundreds of billions of dollars to help.
But will the plans founder due to Republican resistance? And will even a huge jolt of funding be enough to deal with a graying nation’s growing problems with long-term care?
Our own homes provide a cornerstone of Democratic proposals to deal better with nightmares with the cost, safety, and availability of long-term care. Instead of sinking yet more public money — via Medicare and Medicaid — into institutions, can the federal government, instead, improve funding so seniors, the ill, and injured can stay home and get treatment there? As the Washington Post reported:
“The White House’s American Jobs Plan calls for spending about $400 billion over eight years on ‘home- or community-based care’ for the elderly and people with disabilities. That amounts to roughly a fifth of the overall price tag of … the first of two related economic proposals expected from the White House. The prominence of the proposed home-care expansion … reflects the growing alarm by some experts about the nation’s inability to absorb the enormous growth in its elderly population — a challenge that threatens to strain an already limited workforce of caregivers; complicate the retirements of millions of people; and force many children, particularly daughters, out of the labor market to care for their parents. White House officials have also stressed they aim to improve the low pay and working conditions for caretakers.
“In 2018, the last year for which data are available, the United States spent about $130 billion on long-term care through Medicaid, with about $71 billion of that going to home care, according to the Department of Health and Human Services. Biden’s plan amounts to as much as $50 billion a year for home care in additional spending, close to doubling the existing amount.”
As substantial as that sum may seem, it may not be enough. As the newspaper also reported:
“The scale of the problem is significant. The number of seniors is projected to grow by more than 40 million, approximately doubling, by 2050, while the population older than 85 will nearly triple. Unlike most other industrialized nations, the United States does not provide a public long-term-care benefit for all older adults. Care facilities are strapped for funding and struggle to recruit staff, a trend exacerbated during the dangerous working conditions of the coronavirus pandemic. The median salary for a home-care worker is approximately $17,200 per year, said Leslie Frane, executive vice president at SEIU, in large part because the United States pays only limited amounts to states to compensate them for Medicaid care in the home. More than half of home-care workers are on some form of public assistance such as food stamps, Frane said. They are overwhelmingly female and far more likely to be people of color than the general population. ‘We have the largest older population we’ve ever had and really no infrastructure in place to support dignified care and services. And the care workforce we have is shockingly undervalued,’ said Ai-jen Poo, co-director of Caring Across Generations, which advocates long-term care and was consulted by the White House about its plans.”
Experts for years have warned the nation has been too slow to deal with its caregiving crisis, notably for a difficult and increasing group — individuals with dementia, including its most common form Alzheimer’s. The heavy burden of caregiving too often has gone unrecognized.
In my practice, I see not only the harms that patients suffer while seeking medical care, but also the damage that can be inflicted on them by abuse and neglect in nursing homes and other long-term care facilities. Families often have few choices for loved ones needing 27/4 care but these problematic institutions, which charge on average a steep $100,000-plus for a single-room.
The carnage that has occurred in nursing homes facilities during the coronavirus pandemic has only accelerated the urgency with which our rapidly graying nation needs to address our long-term care crisis. The administration has not fully detailed its home-based plans, saying extensive negotiations will be required with Congress.
Lawmakers should not delay, nor should they politically posture. Our needs our demonstrably great and our work ahead huge. We need more, better, safer, and less costly options for the most vulnerable among us to live decently — not die — in warm, compassionate, and healthy places.