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Universal coverage of long-term care for older Americans may stabilize provider revenues


The COVID-19 pandemic’s heavy toll on older Americans highlights the need to strengthen the nation’s safety net for people in need of long-term services and support, an Oregon Health and Science University researcher and co-authors argue in a new report published by Milbank Quarterly.

The report proposes a system of universal coverage to support the long-term care of all older Americans. The purpose would be to protect against financial catastrophe, and to move away from a system in which only the poorest Americans are able to access coverage via Medicaid. 

In addition to benefiting individuals and families, the authors argue this would also create a more stable and generous funding stream for providers.

Dr. Walt Dawson, assistant professor of neurology in the OHSU School of Medicine, said he believes the pandemic could be an inflection point to improve the U.S. system of long-term services and support. Also a senior Atlantic Fellow of Equity in Brain Health with the Global Brain Health Institute, Dawson studies the public policy implications of Alzheimer’s disease and other dementias — including the financial impact on families and the public programs that finance care.


The report lays out a series of recommendations to repair what it characterized as a fragmented and patchwork system of long-term services and supports for older Americans living with physical and cognitive impairments.

For the long term, it calls for establishing universal coverage for all Americans’ long-term care needs through Medicare. “Universal coverage is essential to achieving greater equity in access and coverage, but it is also essential to the fiscal viability of the financing mechanism (e.g., everyone pays into the system),” the authors write.

It also calls for creating an age-friendly health system, and for better collaboration between public health, health systems and long-term care to safeguard the wellbeing and safety of older adults.

Dawson and his colleagues also offer a number of near-term recommendations, including improved reporting of COVID-19 infections. Specifically, they call for improving a “lack of publicly available information” nationally about COVID-19 infections among people receiving long-term services and support, and the workforce caring for them.

Family caregivers, they said, could be identified through Medicare and compensated at the rate of home health aides, necessitating improved lines of communication between acute care facilities and other forms of long-term services and support.

Lastly, the team called for equitable treatment. Medicaid reimbursement, they said, should provide resources to support independent long-term care and home care providers, who often care for vulnerable and medically fragile older adults.


For their part, older Americans are worried about their ability to afford healthcare, with 58{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca} of those aged 65 or older showing concern about their ability to afford future healthcare costs, according to an October 2020 poll from

Half are worried that a major health situation in their household could lead to bankruptcy or debt, while 32{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca} said they would use retirement savings to treat a severe illness such as COVID-19. More than three in 10 reported a surprise medical bill in the last two years.

The findings have implications for providers seeking to maintain care quality during the pandemic, a particularly troubling proposition given that many patients of all age groups are electing to forgo even routine care in the midst of the pandemic.

Twitter: @JELagasse
Email the writer: [email protected]


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