Solving the Home Care Crisis at the State Level

The riddle of how to best serve the aging population has become increasingly complex, as the demand for long-term services and supports (LTSS) is expected to surge over the next few years amid significant workforce challenges, the preference among Americans to age in place and limited resources to make that possible for much of the population.

Current programs and solutions for long-term care won’t do the trick. Medicare and Medicaid have their restrictions, and private pay options aren’t always within reach for many families. Institutional settings like skilled nursing facilities aren’t necessarily the best answer, either, nor are they where many seniors want to reside.

That’s why Caring Across Generations recently released guidelines on what can be done at the state level to design a new care solution—one that aims to expand coverage and access to affordable home care. The goal of the report, titled “Preparing for the Elder Boom: A Framework for State Solutions,” is to present components of a statewide insurance program, the necessary financing mechanisms to support it and ways to bolster a strong workforce to make it all possible.


The recommendations outlined in the report urge states to consider the following in establishing such a benefit:

  • Potential impact: States must determine their population’s need for long-term care, as well as estimated costs.
  • Benefits floor: States must ensure their benefits are sufficient in terms of the amount, duration and scope to reach the best outcomes and supports they can for their residents.
  • Program structure: States should decide between two structures: one which creates an interest yielding long-term care benefits fund, or one within the state Medicaid system through which participants with higher incomes qualify for benefits.

Also important to weigh is how the program will be paid for, and by who. Some options include progressive taxation or taxing estates and inheritances, among others. It’s also recommended that every state have a workforce development plan to ensure high quality of care administered through the system.

Such a program isn’t meant to replace Medicare and Medicaid, but rather help, Josephine Kalipeni, director of policy and partnerships at Caring Across Generations, said during a teleconference Wednesday.


Massachusetts, for example, is already working in several of the areas mentioned. Its home care program serves around 45,000 of 1.2 million seniors, and is open to individuals across a greater income scale than Medicaid alone. The state is also working with community colleges, as well as low-wage workers, to strengthen its work force.

Still, there’s work to be done.

“I think these types of documents help us in our thinking about aging and exploring future models and options,” said Alice Bonner, secretary of elder affairs in Massachusetts.

Over the next few years, Caring Across Generations will partner with state organizations interested in creating campaigns to bring before their legislatures. Currently, Caring Across Generations is working with Maine and Michigan on how to construct a proposal, and is in exploratory conversations with eight other states about doing the same.

Written by Kourtney Liepelt

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