Long-Term Care In The United States: An Overview

PROLOGUE: Elderly Americans are just about the only group of U.S. citizens whose health care is universally insured as an entitlement. However, elders who need long-term care have much less protection. Medicare, the federal program for the elderly and disabled, covers many of the costs of acute medical care but only tangentially covers some long-term care services. Medicaid, the federal/state health program, covers long-term care but only for people who are poor or who become poor paying for long-term care or medical care. Who gets what kind of services under Medicaid varies from state to state. This paper outlines the financing of the U.S. long-term care system and the policies that define it, pointing to the imperative for change to assure adequate services at an acceptable cost. Judith Feder, a political scientist, is dean of policy studies at Georgetown University in Washington, D.C. In addition to directing and teaching in the Georgetown Public Policy Institute, Feder regularly conducts policy research. She served as principal deputy assistant secretary for planning and evaluation in the U.S. Department of Health and Human Services during the first Clinton administration. Harriet Komisar is an assistant professor at the Georgetown Institute for Health Care Research and Policy. She was formerly a principal analyst at the Congressional Budget Office and holds a doctorate in economics from Cornell. Marlene Niefeld is a research associate at that institute; she holds a master's degree in public policy from Georgetown. ABSTRACT: Although long-term care receives far less U.S. policy attention than health care does, long-term care matters to many Americans of all ages and affects spending by public programs. Problems in the current long-term care system abound, ranging from unmet needs and catastrophic burdens among the impaired population to controversies between state and federal governments about who bears responsibility for meeting them. As the population ages, the pressure to improve the system will grow, raising key policy issues that include the balance between institutional and noninstitutional care, assurance of high-quality care, the integration of acute and long-term care, and financing mechanisms to provide affordable protection.