The past year hasn’t been good to the long-term care industry. The pandemic has changed our understanding of nursing homes and assisted living communities. For months, residents and seniors were asked to wait in their rooms with hardly any contact with the outside world. Families couldn’t be with their loved ones, even as they passed away.
Overall, the virus killed 174,000 long-term care residents, putting a harsh spotlight on our country’s elder care system.
That’s why the Biden Administration’s $2 trillion infrastructure package sets aside $400 billion for improving the LTC industry. Will it work?
A Crumbling Infrastructure
The American Jobs Plan, unveiled at the start of this month, would pump hundreds of billions of dollars into the country’s caregiving industry over the next eight years. The administration believes that LTC care facilities are not the only solution to the aging population.
Ari Ne’eman, senior research associate at Harvard Law School’s Project on Disability, says, “There’s a much greater understanding now that it is not a good thing to be stuck in long-term care institutions” and that community-based care is an “essential alternative, which the vast majority of people would prefer.”
According to a 2018 survey from the AARP, 76% of Americans age 50 and older would prefer to remain in their current residence and 77% would like to live in their community as long as possible. However, just 59% say they anticipate they will be able to stay in their community, either in their current home (46%) or a different home still within their community (13%).
That was before the world watched as COVID-19 claimed thousands of nursing home residents. The pandemic has likely increased the number of people looking to age in place.
Katie Smith Sloan, president of LeadingAge, a national association of more than 5,000 nonprofit nursing homes, assisted living centers, senior living communities, and home care providers explains, “The systems we do have are crumbling” due to underfunding and understaffing, and “there has never been a greater opportunity for change than now.”
Around 53 million family members across the country perform primary care for a family member, including an aging parent, a child, or persons with disabilities, without financial compensation, which can take a physical and emotional toll on the caregiver. According to AARP, family caregivers on average devote about 24 hours a week to helping loved ones and spend around $7,000 out-of-pocket annually.
With nursing homes and assisted living communities costing upwards of $50,000 a year, many families choose to care for their loved ones at home, but Medicare only pays home-based providers if they are a registered nurse or therapist. CMS doesn’t pay 24-hour caregivers or homemakers.
According to the Kaiser Health Network, Medicaid can help fill in the gaps, but half of states spend twice as much on institution-based care as they do on community-based care.
What’s in the Plan?
The Biden Administration is betting on home-based care as a potential solution to the ongoing LTC crisis. The plan would provide funding to community-based providers as an alternative to traditional elder care facilities.
However, it’s not clear how much will go towards home-based providers or strengthening the LTC workforce. Some money may also go towards eliminating wait lists for nursing homes. Experts would also like to see the government invest in reducing inequalities in the LTC industry.
“We want to see funding to states tied to addressing those inequities,” said Amber Christ, directing attorney of the health team at Justice in Aging, an advocacy organization. She would like to see expanded tax credits for caregivers, additional Medicare home health benefits, and the removal of the requirement that people receiving Medicare home health be homebound.
“We should be looking more broadly at potential solutions that reach people who have some resources but not enough to pay for these services as well,” she added.
The Biden Administration is also proposing investing $100 billion in expanding access to high-speed internet in rural areas as part of its infrastructure plan. This would give home caregivers more access to online services, telehealth, and medical expertise to help them care for their loved ones.
Ai-jen Poo, director of Caring Across Generations, a national group advocating for older adults, individuals with disabilities, families, and caregivers called the proposal a “historic and profound” opportunity to build a stronger framework of services for those that require considerable ongoing assistance.
“This [plan] isn’t everything that’s needed, not by any step of the imagination,” Poo said. “What we really want to get to is universal access to long-term care. But that will be a multistep process.”
The bill faces steep odds in Congress, where Democrats hold a slim majority. If the bill becomes law, hopefully more people will have access to affordable long-term care.