In “America’s Long-Term Care Conundrum,” Guest Editor Ruth Katz succinctly lays out the psychology behind not planning for our own needs in older adulthood, especially the need for long-term care, and describes what she learned in a listening tour of the United States, wherein she was schooled in what happens on the ground when people need and use long-term services and supports. Our current way of financing LTSS is unsustainable, Medicaid is not the solution, family caregivers are at a breaking point, and politics are standing in the way of a solution. But there is hope in learning from how other countries have solved their similar long-term-care quandaries.
Barbara Coulter Edwards and Aditi P. Sen, in their article, “High Demand and Fragmentation: The Current State of Long-Term Services and Supports in America,” explain the current challenges to financing long-term care, especially as people age into the frail elderly category; how increasing levels of cognitive decline will affect long-term-care costs; workforce shortages (which may be exacerbated by new immigration policies); and how policy makers and legislators might approach solutions through coordinated state and federal efforts.
In “Re-imagining the Delivery of Care for Older Adults with Chronic Conditions,” Howard Gleckman describes how the delivery of medical treatment and social supports in the United States is uncoordinated, and degrades the quality of life of older adults with chronic conditions, as well as possibly adding unnecessarily to costs. But now some public policy changes and market initiatives are resulting in the development of new models that better integrate care. What might they look like?
Robyn I. Stone, in her article, “Financing Long-Term Services and Supports—and the Challenge of Underlying Assumptions,” writes of the almost 30 years’ worth of options for financing long-term care that have been explored. Since 1990, policy makers, insurers, providers, consumer advocates, and researchers have struggled with underlying assumptions that affect the nature, scope, and political viability of any long-term services and supports program: Should a program be medical or functional? Is it a quality-of-life issue? Should such a program cover all people or just older adults? Should participation be mandated or not? Should the program be funded at the national or state level? The path ahead remains unclear.
