Illustration: Sarah Grillo/Axios
Rising concerns about the quality and availability of long-term care have brought more congressional attention to the topic, but there are significant disagreements about what the solution should be.
Why it matters: The number of Americans who need long-term care in some form is only expected to rise as the country ages, meaning concern over the already-strained system is well-founded.
Driving the news: The Energy and Commerce Committee's health subcommittee hearing on long-term care this week highlighted the divisions over the Biden administration's proposed nursing home rule, which would establish minimum staffing standards.
- Another proposed rule under the spotlight requires at least 80% of Medicaid payments for home care services to go to caregiver pay.
- Chair Cathy McMorris Rodgers said both rules are too burdensome and actually threaten access to care, and "are not the way forward in supporting seniors and people with disabilities."
- The other side: "These proposed rules are strong first steps to help ensure that patients in both nursing homes and home- and community-based settings are able to get the care they need," Ranking Member Frank Pallone said in his opening statement.
The big picture: Nursing homes, home care services and other forms of long-term care are facing serious staffing shortages, a problem that has both worsened and received more attention in the wake of the pandemic.
- All states reported home- and community-based care workforce shortages in 2023, and 48 states reported shortages among five or more provider types, according to a KFF analysis released last week.
- But this has driven a bit of a policy dilemma: Do regulations designed to improve care conditions force long-term care services to make necessary changes, or do they simply set these services up for inevitable failure?
- The nursing home proposal has divided lawmakers — with Democrats landing on both sides — and stakeholders. But analysts say that the rule ultimately may not be that big of a deal if finalized, my colleague Maya Goldman reports.
Between the lines: Biden's regulatory approach comes a couple of years after he failed to secure hundreds of billions of dollars in new funding for long-term care as part of his Build Back Better agenda.
- But some lawmakers and advocacy groups haven't given up on advancing legislation.
- A group of Democrats led by Sen. Bob Casey introduced legislation last week that would temporarily give more Medicaid funding to states to use to support home and community-based long-term care services.
- A second new bill introduced by a bipartisan group of senators, led by Sens. Ed Markey and Shelley Moore Capito, would require federal agencies to lessen the administrative burden for family caregivers.
- And AARP has made family caregiving one of its top priorities and is engaged across all forms of long-term care issues.
- "This is an issue that is touching individuals and families across the country, including policymakers themselves. So it's something people can resonate [with] — members hear from their constituents about this," said Rhonda Richards, director of government affairs at AARP.
- "Addressing issues of supporting family caregivers, helping people live in their homes, addressing long-term care — these are all important issues," she added.
The bottom line: Long-term care hasn't traditionally been the buzziest issue in the health care world, but demographics all but ensure it'll stay on the political agenda for years to come.
