Bipartisan Policy Center Releases Report “Bipartisan Solutions to Improve Availability of Long-Term Care”

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WASHINGTON, October 9 (TNSRep) – The Biparty Policy Center published a 54-page report in September 2021 titled “Bipartite Solutions to Improve the Availability of Long-Term Care”.

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Contents

5 … SUMMARY AND RECOMMENDATIONS

8 … BACKGROUND

13 … MEDICAID COVER OF THE LTSS

17 … TAX CREDITS FOR CAREGIVERS

20 … IMPROVE THE AVAILABILITY AND AFFORDABILITY OF PRIVATE DEPENDENCY INSURANCE

23 … RECOMMENDATIONS

35 … CONCLUSION

36 … APPENDICES

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Abstract

For decades, policymakers have sought to improve access to, and funding for, long-term services and supports (LTSS). Today, about half of people aged 65 will need SLT at some point in their lives./1

This need will increase as baby boomers age and require more care.

LTSS refers to a wide range of paid and unpaid medical and non-medical services for people with functional limitations due to age, chronic illness or disability./2

LTSS includes assistance with activities of daily living (ADL), such as eating, bathing, or dressing, and instrumental activities of daily living (IADL), such as managing medication or preparing meals ./3

Those in need of SSLT may include children, adults, or the elderly with physical, cognitive, developmental, mental health issues, or other chronic health conditions ./4

In 2018, 14 million adults in United States reported a need for long-term services and supports./5

The challenges associated with providing care to those in need of LTSS include both the cost of care and the shortage of caregivers relative to need. The cost of residential and home care services has increased on average faster than the rate of inflation since 2004./6

Long-term care providers saw their costs increase dramatically from 2019 to 2020, as demand increased and the shortage of caregivers in facilities and in the community worsened. The median of the national annual cost of SSLT in 2020 ranged from $ 19,240 for adult day health care at $ 105,850 for a private room in a retirement home.

The US Bureau of Labor Statistics forecast a 34% increase, or 1.16 million new home and personal care aide jobs, over the 10-year period starting in 2019 – a faster-than-average growth rate for all other professions./8

According to the office’s most recent data, these caregivers earn on average $ 13.02 per hour. Experts predict that low wages will lead to significant labor shortages and worsen access to care for those in need of LTSS./9

By comparison, social workers and social workers – a similar profession with similar educational requirements – earn a median salary of $ 17.29 per hour./10

In addition to low wages, other factors contribute to direct care labor shortages, including labor recruitment and retention issues, high turnover rates, lack of access social benefits and lack of economic security. / 11

The COVID-19 pandemic has exacerbated these trends after nursing homes experienced high infection and death rates and the demand for home and community care increased.

No single solution will meet the needs of those who need LTSS. Improving access to these services will require a combination of public and private sector options and an investment of federal resources. Since 2014, BPC has been working on the development of bipartite solutions to extend access to LTSS. Our work began with a group of four leaders: Former Senate Majority Leaders Tom daschle and Bill frist; former secretary of Health and social services and Gouv. Tommy thompson; and Alice rivlin, former vice-president of Federal Reserve, director of the Management and Budget Office, and director of Congress Budget Office.

BPC’s work has focused on solutions designed to improve the availability of home and community services, improve a struggling private long-term care insurance market, and provide assistance to caregivers. This report presents policy recommendations, including new proposals to expand the availability of home and community services for low- and middle-income people. It also includes previous recommendations that BPC has developed to improve private sector options for those with more financial resources.

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RECOMMENDATIONS

I. Expanding access to home and community services

A. Congress should make Home and Community Services (HCBS) available to people in need of long-term care (LTC) who are not eligible for Medicaid. Services would be available through fully integrated models of care, including Enhanced and Fully Integrated Plans for Double Eligible Special Needs (FIDE-SNP), Comprehensive Care Programs for the Elderly (PACE), or other approved models. by the secretary of HHS, and would include degressive grants.

B. Congress should develop a bridging program to support the expansion and development of integrated delivery models where they are not available, and should build the capacity of caregivers until the new HCBS program is fully implemented.

II. Address disparities in the delivery of HCBS

A. Congress should direct the secretary of HHS to collect data and publish an annual report on disparities in access to HCBS and make recommendations to Congress to address the inequalities.

III. Create a tax credit for caregivers

A. Congress should establish a refundable caregiver tax credit to help cover the cost of paid care related to SSLT.

IV. Improve the viability of Private long-term care insurance

A. Congress should standardize and simplify private long-term care insurance to achieve an appropriate balance between coverage and affordability, through “long-term care retirement insurance (LTCI)”. B. Encourage employers to offer an LTCI pension and automatically enroll certain employees (aged 45 and over with minimal retirement savings), with a withdrawal option like many employer-sponsored retirement savings accounts .

C. Congress should allow early withdrawal without penalty from retirement savings accounts to pay LTCI retirement premiums.

D. Congress should ask the NAIC to amend model laws and regulations to accommodate products moving from life insurance to long-term care.

V. Establish a Public education campaign for long-term care

A. The Financial Literacy and Education Commission and partner federal agencies should coordinate to strengthen LTC educational resources and integrate LTC planning with retirement education topics.

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Conclusion

There is no politically viable solution to meet the country’s LTSS needs. Bipartite policy solutions that improve the LTSS delivery system could help meet the growing demand for these essential services in United States. BPC’s recommendations have the potential to expand access to LTSS for people in need of long-term care across a range of income levels, through public and private health insurance programs. We encourage long-term care planning by improving public education, while providing some financial relief to unpaid family caregivers who remain critical providers in the LLO delivery system. We hope that these recommendations will advance discussions among policymakers to support bipartisan policy solutions that improve access to LTSS for children, adults and the elderly with functional or cognitive disabilities.

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The full report, including footnotes, can be viewed at https://bipartisanpolicy.org/wp-content/uploads/2021/09/BPC_Health_Long_Term_Care_RV4-min.pdf

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