Government’s Role in Aging and:
ANDREW E. SCHARLACH AND AMANDA J. LEHNING
The most notable feature of long-term care (LTC) policy in the United States is the lack of federal policy leadership. By default and design, responsibility for LTC has fallen to local and state governments, and ultimately to the elderly individuals requiring assistance and to their families. Lacking any overall nationwide approach, the United States has a fragmented patchwork of isolated communitybased programs which, while sometimes innovative, serve relatively small numbers of disabled seniors. The consequences for those in need of LTC include inadequate care and substantial vulnerability to impoverishment in later life, especially for the most disadvantaged Americans. Further, this system depends on the unpaid contributions of family caregivers, who provide the majority of longterm care in this country, as well as the underpaid services of formal providers.
This chapter begins with a brief discussion of the context of long-term care policy in the United States, including an overview of long-term care settings and financing. We then describe disparities regarding care needs and related costs, followed by an analysis of public reimbursement and regulatory policies that have contributed to these disparities. We conclude with proposed policy solutions that could result in a more equitable distribution of long-term care costs and burdens, and help federal, state, and local governments better meet the needs of long-term care recipients and their families.
Long-term care (LTC) refers to a “variety of ongoing health and social services provided for individuals who need assistance on a continuing basis because of physical or mental disability.”1 Approximately 10 million adults in this country