Long-Term Care: Confronting America’s Next Great Challenge

At kitchen tables across America, families are confronting the same question: How will we care for mom or dad or another loved one if something happens and they can’t care for themselves without assistance? If you aren’t a caregiver today, you have been one or you will be one. And who will care for you?

With 62 million family caregivers providing $450 billion in care over the course of 2009, these concerns go beyond the kitchen table. Thinking about long-term services and supports is a deeply personal challenge for a family to confront. And while the personal side of these issues may not translate easily into policy, a 15-member, federally appointed Commission on Long-Term Care just released a report with serious, bipartisan recommendations to help build a better system to support individuals and their family caregivers nationwide.

The need for long-term services and supports (LTSS) affects millions of people, including older Americans, persons with disabilities and their family caregivers.  Close to half of those who need long term services and supports are under age 65 and nearly 70 percent of individuals who reach retirement will need long-term care at some point in their lives. By 2030, older Americans will make up 20 percent of the population, up from approximately 13 percent now. The costs of home care services, assisted living accommodations and nursing home care are becoming prohibitively expensive and putting unprecedented strain on family budgets and Medicaid, which pays for the long-term care costs of those who impoverish themselves paying for care. Private insurance options for long-term care are becoming increasingly scarce and too expensive or unavailable for most families.

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Adding to the seriousness of the problem, AARP’s Public Policy Institute recently released a report that finds that the number of family caregivers available for older Americans will drop dramatically in coming years. From 1990 to 2010, the Baby Boom generation entered their prime caregiving years; at the end of those two decades, there were 7.2 potential caregivers aged 45-64 for every person aged 80-plus. Over the next 20 years, as the Boomers become the population that will need the most care, the number of potential caregivers drops to 4.1. Looking even further out, between 2030 and 2050, the number plummets to 2.9. That means more people dependent on fewer family caregivers. We need more options to support family caregivers and recruit and retain a strong, stable paid LTSS workforce with better career opportunities to meet the need.

These stark numbers illustrate why the Commission on Long-Term Care spent a portion of its time formulating recommendations for providing better support for family caregivers – the backbone of America’s long-term care system. Importantly, the Commission called for a national strategy to address the needs of family caregivers. The Commission specifically recommended assessing family caregivers and their needs in the care planning process, including family caregivers in patients’ health records and as a member of care teams, ensuring family caregivers have access to relevant information technology and, importantly, encouraging family caregiver interventions, including respite options and volunteer support.

In addition to providing support to family caregivers, the Commission endorsed the broader ideas that people should have greater choice about care setting and that home and community-based services should be made robust enough to meet the needs of older Americans and people with disabilities who wish to remain in their homes and communities.

While these recommendations are a good start, they are only one step in what must become an ongoing conversation. The Commission had limited time and regrettably did not reach agreement on comprehensive long-term care financing.  Solutions on these and other issues are critical.  The Commission's full report illustrates the need for continued dialogue among individuals and the public and private sectors, and action to address long-term care in our country. Congress and the Administration should take a serious look at these recommendations as they explore ways to tackle the long-term services and supports crisis.

Given the complexity and urgency of the challenges facing America’s families, it is high time we broaden the conversation about long-term care—moving it beyond kitchen tables and getting serious about policies that support people who need and provide ongoing services and assistance.


Nancy LeaMond is executive vice president, state and national group at AARP.