ElderWeb

The current issue of Health Affairs includes an article entitled "Long-Term Care In The United States: An Overview," by Judith Feder, Harriet L. Komisar, and Marlene Niefeld. In this article, the authors do an excellent job of exploring the problems of access to, and funding for, home and community-based long term care services for the elderly in the United States.

The authors discuss the fact that Medicaid's focus on institutional, rather than community-based, long term care makes it harder for people to access the care they need at home, but also noted that it is likely that public funding costs will increase if Medicaid covers more services in the home. Increases would come from the cost of providing help to the many community-dwelling seniors currently unable to get the assistance they need, due to the cost or inavailability of services. The authors note that the public is aware of significant quality assurance problems in nursing homes, but that monitoring quality care in the home will be even more difficult than it has been in nursing homes. They also suggest that long term care insurance will be critically important in financing long term care, since insurance is best used to cover costs that are catastrophic and unpredictable, like long term care costs.

Judith Feder, a political scientist, is dean of policy studies at Georgetown University in Washington, D.C.