Report to Congress: Home Care Essential to Solving Long-Term Care Crisis

Concerned that a report to Congress last week on the future of long-term care did not address key issues for ensuring long-term services and supports, Long-Term Care Commission members submitted an alternative report that underscores caregiver protections and access to home health care as viable solutions.

Among people now turning age 65, an estimated three in 10 will never need long-term supports and services (LTSS), however, two in 10 will need five or more years of LTSS, according to the report titled “A Comprehensive Approach to Long-Term Services and Supports.”

To ensure that the nation’s elderly and people living with disabilities receive the LTSS they need, Commission members recommend strategies to improve the national caregiving workforce and broaden access to Medicare’s post-actue care benefit. 


 Although the demand for direct care workers is projected to expand 70% by 2020,the LTSS labor pool is dwindling, notes the Commission. And as this profession experiences a turnover rate that is 13%-18% higher than the overall labor force, there is a widening gap between the future supply and demand for these workers.

“To ensure the high-quality services for individuals and their families in all service settings, the law must assure that direct-care workers are paid a living wage, are well trained and have opportunities for career advancement,” writes the Commission. 

This recommendation also entails adopting a national strategy to recognize and support families in their caregiving roles, especially as 91% of people receiving LTSS receive them via family caregivers, according to data cited in the report.


“To assure that families are able to care for their loved ones today and in the future, family caregivers must be at the center of a comprehensive approach to LTSS reform,” writes the report.

Under this strategy, family caregivers would have access to educational resources, training opportunities and professional supports as a means to integrate them into a comprehensive LTSS system. 

Another recommendation provided by Commission members in their alternative report includes broadening access to Medicare’s post-acute care benefit, so as to reduce barriers to home health and other post-acute care therapies such as skilled nursing facilities.

Part of this includes removing the 3-day hospital stay requirement for skilled nursing facility coverage. This, according to the report, would help people without the need for an acute inpatient hospital stay at least receive some Medicare nursing facility coverage. 

The recommendation also calls for revising the “homebound requirement” for Medicare home health coverage so that people who cannot obtain the services they need outside the home can receive them at home. 

Commission members also expressed a distaste for home health co-pays. 

“One way not to improve Medicare home health coverage is to impose cost sharing for home health care visits or to an annual coverage cap,” it says in the report.

Proposals currently being considered on the topic of home health co-pays, the Commission writes, would further “exacerbate the already limited ability of people to obtain home and community-based services.”

“Our goal throughout this process was to offer Congress, the President, and the public a vision of what is truly necessary to meet the needs of people who require long-term services and supports today—and of any of us who may need them in the future,” the report concludes. “We’re all at risk, and we’re all responsible for building a comprehensive LTSS system.” 

Written by Jason Oliva

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