Vice President Kamala Harris shared a new proposal on Tuesday to require Medicare to cover the costs associated with in-home long-term care, potentially allowing seniors and individuals with disabilities to receive care in their homes rather than in skilled nursing facilities.
The proposal could have broad appeal for middle-income Americans who don’t qualify for Medicaid. However, if passed, it would likely only have an incremental impact on skilled nursing care, experts told Skilled Nursing News.
“Even with this benefit, it’s hard to imagine that many older adults [in skilled facilities] could live sustainably in their own home. There will certainly be a need for nursing homes [and] this would have more of a marginal impact,” said Fred Bentley, managing director of ATI Advisory’s post-acute, long-term care and senior living practice. “There are still going to be plenty of older adults who, even with this kind of benefit, have such significant ADL needs that it’s just not going to be sufficient.”
Of course, Harris’ in-home care proposal would require congressional approval, which is difficult to predict, but judging by the fate of Biden Administration’s less robust proposals in the arena, the Harris plan might be a hard sell, Bentley said.
That said, if the new proposal were to be implemented, Bentley said, “You could envision those beneficiaries living independently, for a much longer time, and not having to spend down to qualify for Medicaid.”
Medicare generally does not provide coverage for long-term care services at home. Instead, Medicaid serves as the main source of public assistance for this type of care, but families must prove they have a very low income to be eligible. Additionally, coverage and eligibility requirements can differ significantly from state to state. This leaves many middle-income families facing overwhelming financial burdens when caring for elderly relatives.
Analysts suggest that Harris’s proposal could resonate with the electorate – especially with a certain demographic.
“It is tapping into a sentiment and a desire amongst many folks to have a more robust home care program and to have Medicare cover that,” said Bentely. “For the demographic that the Harris campaign is very interested in – women in the sandwich generation – it would resonate.”
In terms of what the proposal covers, there is a cost sharing component based on a sliding scale related to income, which would be new ground for Medicare coverage, Bentley said.
“The co-pays or co-insurance would vary based on income level,” he said, adding that a lot of details still need to be worked out, but it could be beneficial for women in the middle income group. “But on the face of it, I would think a lot of individuals in that segment would feel some relief.”
Although necessary, nursing home stays can be costly, second only to 24/7 home-health aide expenses, and almost twice as much as assisted living facility stays, according to a KFF analysis.
The costs associated with 24/7 in-home care are staggering, however. KFF estimates that hiring a professional live-in home health aide for 24/7 care can exceed $288,000 annually.
And Harris’s proposal could potentially cost around $40 billion each year, but the funding, she suggested, would come from the government’s savings through negotiating lower drug prices with pharmaceutical manufacturers, an CNBC news story noted.
Currently, over 37 million people in the United States provide unpaid care for seniors, comprising approximately 14% of the adult population, as reported by the U.S. Bureau of Labor Statistics. The majority of these caregivers – around 59% – are women, who often have to balance care responsibilities with jobs and other family obligations. Harris emphasized the immense challenges these caregivers face, particularly those who support both aging parents and their children.
“It’s just almost impossible to do it all, especially if [caregivers] work,” Harris said at an appearance on “The View,” on ABC. “We’re finding so many of them are having to leave their jobs, which means losing a source of income, not to mention the emotional stress.”
It is not clear whether the proposal would allow family members to be compensated for the care of loved ones, similar to the way certain states allow Medicaid to reimburse such care, Bentley said.
Staffing problems could derail success
Long-term care advocacy groups applauded Harris’ home care proposal, but noted that the staffing shortages that have confronted all sectors of long-term care, including home health, need to be ironed out for such a proposal to be successful.
“Adding home care to the Medicare program, a much-needed component of a broader long-term care financing reform effort, will offer millions of older adults and families access to services that promote quality of life and safety as people age at home,” Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit providers of aging services, said in a statement. “At the same time, we cannot overstate that without staff, there is no care. Continued attention and investment in the workforce, as noted in the proposal, remains essential.”
It has been decades since a major proposal of this kind has been put forward to assist middle-income families with the escalating costs of home care, according to experts at KFF.
Smith Sloan also stressed the need for new ideas to address the long-term care crisis.
“Rarely do we see a proposal with this level of specificity included in a Presidential platform,” she said. “Our country’s population is aging – and demand need for long-term care and services is growing. Nonprofit providers of aging services have long warned that our current patchwork approach to long-term care delivery and financing is broken. Too many people struggle to access the help that’s needed as we age.”
And one of the goals of the new proposal is to provide savings for all, Harris said.
“We’re going to save Medicare money because we’re not going to be paying these high prices,” Harris said, framing the proposal as both a compassionate initiative and a fiscally responsible move.
Drawing on her personal experience, Harris recounted the challenges of caring for her mother, who battled cancer before passing away in 2009.
The implications of this plan extend beyond just alleviating caregiver burdens. Research from AARP indicates that over two-thirds of adults aged 50 and older prefer to stay in their homes for as long as possible.