Background
Due to the high cost of long-term services and supports (LTSS), many older adults fear impoverishment and becoming a burden to their families. There is limited third-party coverage to ease this fear. As the baby boom generation ages, the need for services will increase at a time where there will be fewer family caregivers to provide such care. The uncertainty of needing LTSS, and the potentially catastrophic costs associated with it, lend itself to a social insurance solution where risk and costs are shared. Spreading risk widely is the best way to expand coverage and lower per-person costs. If everyone contributes, then everyone is protected.
In 2010, the ratio of potential caregivers age 45–64 to those at high risk of needing care (age 80 and older) was 7:1. By 2030, that ratio is projected to decline sharply to 4:1 and to further fall to less than 3:1 in 2050. By that time, baby boomers will be in the high-risk years of late life. Higher divorce rates and childlessness will further diminish the availability of family care.
To address increased demand, the U.S. needs a comprehensive national policy for LTSS. Without it, programs will operate in isolation and fail to best serve the millions of people with health care and LTSS needs. For too long, LTSS have lacked a holistic focus. A more global approach would help people overcome the full range of obstacles to living in the least restrictive setting possible and maximize their potential for self-determination. A comprehensive, person- and family-centered LTSS policy would meet consumers' needs. It would also support family and friends in their caregiving role and create efficiencies in public spending.
Until a comprehensive national LTSS program is implemented, states can take interim steps to ensure that LTSS are affordable and fiscally sustainable both to individuals and governments. These efforts can also enhance the financial security of individuals and their families from the potential risk of impoverishment.