November 21, 2013

Tom Daschle, a former Senate majority leader, is a co-founder of the Bipartisan Policy Center. Tommy Thompson is a senior fellow at the center and a former governor of Wisconsin. He was secretary of health and human services in the George W. Bush administration.

Nearly 70 percent of Americans who reach age 65 will, at some point, be unable to care for themselves without assistance. Issues of long-term care also affect millions of younger people with significant cognitive or physical functional limitations. Yet long-term care gets neither the public attention nor the policy focus that it deserves.

The scope of the challenge before our nation was recently summed up by the Commission on Long-Term Care. In its final report to Congress, the federally appointed bipartisan group wrote that in today’s system, services and supports “are highly fragmented and difficult for individuals and family caregivers to access” and that the system “lack[s] the focus and coordination across agencies and providers necessary to ensure the best outcomes for the person and family.” Services are also “provided in ways that can be expensive and inefficient.”

Approximately 12 million Americans require long-term care. Adults age 65 and older make up 56 percent of that group. The vast majority of long-term care in this country is provided, unpaid, by families. Valued at about $450 billion a year, it depends on people’s ability to juggle paid work, family responsibilities and care for loved ones. Paid care, whether in homes or in community-based or institutional situations, is worth some $211 billion a year, with the federal and state governments footing $131 billion of that cost through Medicaid.

Demographic shifts are poised to exacerbate this patchwork system, stretching family resources and Medicaid budgets. By 2030, older Americans will account for 20 percent of the population, up from about 13 percent in 2010. In 2010, there were 7.2 potential caregivers ages 45 to 64 for every person age 80 or older; over the next 20 years, as baby boomers age and require care, the number of caregivers is on track to drop to 4.1. Between 2030 and 2050, it is expected to decline further, to 2.9. Family caregivers, the backbone of today’s system, will not be able to fully provide the care needed by this growing cohort of older Americans.

Widespread misunderstanding of who will need and who will pay for long-term care keeps many Americans from pushing for tangible solutions. An Associated Press poll funded by the SCAN Foundation — a nonprofit focused on health care for seniors — found this spring that a whopping 60 percent of Americans report never having talked to family about their care preferences. Forty-four percent of individuals polled believe, incorrectly, that Medicare will pay for long-term care.

As our country considers how to address this issue, a few things stand out:

First, we must figure out how to build a more integrated, efficient, person- and family-centered system of long-term care that ensures that people can access quality services in the settings they choose.

Second, the huge burdens on family caregivers must be more widely shared.

Third, more and better financing tools must be established to help people pay for services.

Fourth, Americans must be educated about how to make smart financial and health-care decisions earlier in life so that the odds of postponing a long-term-care event are increased and the odds of being financially ruined by such an event are decreased.

Solutions are within reach, thanks in part to the work done by the federal Commission on Long-Term Care as well as the Leading­Age Task Force, which in September released its own recommendations on improving quality, service and support of long-term care.

We intend to do our part to push toward those solutions by co-chairing a Bipartisan Policy Center Project on Long-Term Care with former Senate majority leader Bill Frist (R-Tenn.) and former White House Office of Management and Budget director Alice Rivlin.

It’s time for a national discussion on long-term care. We must confront this challenge constructively and without the rancor of recent health policy debates. It is far too important to ignore.