Most eldercare advocates in the United States are fully occupied pushing for effective allocations in the current reconciliation bill. This activity offers the opportunity to plant the seeds of Long-Term Services and Supports (LTSS) reforms that are not yet likely – but are worthy and important. So, yes, we need to argue strongly for Medicaid funds to increase pay and require benefits for direct care workers, and maybe we’ll even get a little funding for information infrastructure and some public education about long-term supports and services. In addition, let’s start familiarizing policymakers about more difficult, more fundamental LTSS reforms – just to start getting these included in the policy discussions. It’s said that an adult has to hear a new idea a dozen times before they start to make it their own!
What seeds should we be planting? I’d recommend serious work on financing for the long term, like the WISH Act. I’d recommend serious work on housing – let’s get affordable, disability-adapted, and services-connected housing widely available. This will require tackling restrictive housing regulations, building back better after catastrophes, and integrating supported senior housing into communities. I’d go for reforming congregate facilities of all sorts to be more home-like, smaller, and more often integrated into communities.
The categories that the United States uses for LTSS issues have created thoroughly dysfunctional silos, from the perspective of eldercare — medical care, behavioral care, custodial care, rehabilitation, community-based services, nursing homes, assisted living facilities, family care, personal care, homemakers, and so on. What we need is to live in communities where eldercare has been anticipated and planned, since most older adults end up needing most of the services now in silos. So, we could be planting the seed of the idea of generating a local entity that has data, authority, and some finances to set priorities for improvement, implement improvements, and monitor the performance of eldercare locally. At least, CMMI could sponsor a multi-year LTSS improvement trial in a couple dozen communities. Let’s see just how much better eldercare could be – more reliable, more equitable, more supportive of older adults and their families!
Keywords: LTSS, advocacy, reconciliation