To make aging at home a sustainable option for older adults, governments and health care providers must establish stronger payment frameworks and care coordination systems to support older adults and the people who care for them, according to a new publication from the Milken Institute’s Future of Aging and Longevity team.
Caregiver shortages and Medicaid cuts threaten access to home-based care and risk shifting more responsibility onto family members — potentially forcing them to scale back paid work and jeopardize their own financial security, according to Diane Ty, managing director of the Milken Institute’s Future of Aging and Longevity.
“Even if you had the financial means to bring a paid caregiver into your home, there’s shortages and exacerbated in some zip code areas and others, and so right now a lot of that is falling on the family caregivers,” Ty said.
Santa Monica, California-based Milken Institute is a nonprofit, nonpartisan economic think tank. On Oct. 20, its Future of Aging and Longevity team published “A Decade of Progress, A Decade to Act,” assembling essays and practitioner perspectives on the systems needed to support longer lives.
Aging care should be treated as essential public infrastructure, according to an essay included in the report authored by Sarita Mohanty, president and CEO of The SCAN Foundation, and Kapil Dhingra, a physician leader at Kaiser Permanente. This would include making long-term care affordable and available at home and improving coordination for people enrolled in both Medicare and Medicaid.
However, an insufficient labor pool will be a large detriment to home-based care access. The federal government’s immigration crackdown exacerbated existing labor shortage issues, Ty said. As a result, gaps in paid care can force family members to reduce their work hours or leave their jobs altogether.
The decision to leave employment can affect not only current household income but also employees’ retirement cotributions and future Social Security benefits, Ty said. She added that Medicaid cuts could intensify those trade-offs.
“They’re going to have real impacts on families who are already stressed with affordability, and then they’re going to have to make tough decisions about work,” Ty said.
If family caregivers reduce paid employment, governments could collect less tax revenue, Ty said.
Caregiving responsibilities also impact younger generations. Approximately 4 million U.S. children under 18 are family caregivers, according to an essay penned by National Alliance for Caregiving President and CEO Jason Resendez and Vanderbilt University School of Nursing Assistant Dean for Student Affairs Feylyn Lewis. Another 5 million young people balance caregiving with postsecondary education.
“You may be the sole breadwinner. You may need to have that job to contribute to the household income. So then, what happens? That falls on a young person,” Ty said.
Mohanty and Dhingra point to the Program of All-Inclusive Care for the Elderly (PACE), a federal program that offers older adults nursing home-level care within their home and community, as an example of connecting care delivery with community support. As a result, recipients live longer, healthier and more meaningful lives, they said.
Expanding integrated home- and community-based care, Mohanty and Dhingra argue, thus requires payment frameworks that reward whole-person outcomes rather than volume, stronger data sharing between health systems and community organizations and a role for families and caregivers in shaping services.
Addressing these challenges requires coordinated action over piecemeal reforms, according to Ty.
“What we need to do is scale that for the next 10 years, and that’s really systems and policy change,” Ty said.
