Researchers are wondering whether the United States can learn something from other countries that have set up long-term care (LTC) finance programs that are supposed to pay for LTC services for all residents who end up needing the services.
The researchers, Nancy Folbre of the University of Massachusetts at Amherst and Douglas Wolf of Syracuse University, have edited a free e-book, Universal Coverage of Long-Term Care in the United States, that includes chapters from people like Howard Gleckman, a retirement policy specialist at the Urban Institute, and David Stevenson, a health policy professor at Harvard.
Some of the other contributors are on the staff at LTC services or long-term care insurance (LTCI) organizations: Marc Cohen, the chief research and development officer at LifePlans; Eileen Tell of Univita; and Mary Jo Gibson, who used to be with AARP.
The editors said they began to work on the book in 2011, after the voluntary LTC benefits program that was part of the Patient Protection and Affordable Care Act of 2010 (PPACA) failed.
Several contributors write about the challenges involved with using some combination of Medicaid, private insurance and "gap filling" insurance to cover LTC costs.
Stevenson, Cohen, Tell and Brian Burwell write in a chapter on LTC finance that there should be more than enough work for all possible LTC financial support providers to go around.
Norway, for example, provides LTC services as a public service, and German provides LTC financing through a universal insurance program.
England, in contrast, has a government LTC program but limits access to benefits through means tests, and that program ends up leaving families with more responsibility to help their older relatives, the researchers say.
Jesse Slome, executive director of the American Association for Long-Term Care Insurance (AALTCI), says he thinks the United States may be getting to a point that will make pressure for LTC system reform hard to resist.
"Americans are aging every day and few have a plan for dealing with the enormous risk of needing long-term care that results from living a long life," Slome says.
The statistics in the Universal LTC book show that the percentage of the U.S. population that's now over 80 is comparable to what it was in Germany and Japan when those countries adopted their current LTC finance systems, Slome says.
But Germany and Japan adopted LTC reform goals and policies that meshed well with their existing funding arrangements and cultures, and the United States seems likely to depend more on private-sector financing when it reforms its system, Slome predicts.
The smart thing for consumers who can afford to buy private LTCI is to buy private coverage, not depend on whatever government programs turn out to exist, Slome says.