What is the crisis?

America has no financing system for long-term services and supports (LTSS). Consequently, millions of Americans become impoverished to get help living with conditions such as Alzheimer’s Disease, Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure, Multiple Sclerosis, Parkinson’s Disease, and others.

What are long-term services and supports?

LTSS – also called long-term care – helps people (young and old) who have disabilities or chronic conditions with everyday tasks like bathing, getting dressed, fixing meals, and transportation. 

Assisted living and nursing homes are some of the most visible examples of LTSS; however, most LTSS are provided by family members or a mix of family, friends and neighbors in a person’s home.

Doesn’t private health insurance or disability insurance pay for LTSS?

No. Private insurance – whether provided through an employer or a health insurance exchange – pays for care in a hospital or clinic, which is often referred to as acute care. 

Disability insurance is designed to replace a portion of the income you lose if you’re unable to work due to accident or injury. It provides no additional benefits to pay for LTSS.

Doesn’t Medicare pay for LTSS?

No, but that’s the common myth. If you are 65 or older, Medicare will pay for up to 100 days of rehabilitation services after an acute care episode, but that’s it.

Doesn’t one’s Social Security, 401k and/or IRA cover LTSS?

Yes, private resources can be used for LTSS, but few Americans have the financial assets to fund the LTSS they need. 

For example, annual average costs for nursing home care are over $90,000, and a half-time home health aide services cost around $21,000.

So why doesn’t everyone simply purchase a private long-term care insurance policy?

Only about 9% of Americans carry such policies. Most Americans don’t find them to be an affordable option, and many Americans find the policies confusing.

I’ve heard of people having Medicaid pay for LTSS, isn’t that the solution?

Yes, people use Medicaid, but it’s not a viable public solution for LTSS funding. Medicaid — a federal program in which the costs are shared between the federal government and the states — was designed to provide publicly funded health care for people in poverty. 

It was never meant to be Americans’ default source for paying for LTSS, yet it is now the largest payer in the U.S.

Because the number of older Americans is growing in an unprecedented way, reliance on Medicaid places tremendous strain on taxpayers and government budgets.

If people qualify for Medicaid, isn’t the Medicaid safety net doing what it is supposed to do?

In order to qualify for Medicaid, a person must exhaust all assets: that is, impoverish yourself in order to get care. This makes the LTSS crises especially acute for America’s middle class. 

If you are wealthy, you can most likely pay out of pocket for LTSS. If you live in or near poverty, you qualify for Medicaid. But if you’re in the middle, you are one disability away from being financially wiped out. 

If you’re a younger person, you can be impoverished with a lifetime still ahead of you. We simply don’t have a solution for middle-income Americans.

How does this crisis get solved?

We must work together to solve it. We believe solutions will be built on collaboration between the public and private sectors. 

That’s why we’re building a wide and deep coalition to bring focus to this issue, providing unbiased, transparent information to identify pros and cons of various approaches and building the will to create solutions that help people get the LTSS they need.

Why should we care?

In the end, each of us will need LTSS, or people we love will need LTSS. The solutions, which allow people to live with dignity and without impoverishment, are for all of us.