Here's how to redesign long-term care for older adults after Covid-19:
A public program such as Medicaid still would support this care for those with very low incomes. But Medicaid would be far more flexible than today, and the default setting for care would be people’s own homes, not nursing homes. Today, Medicaid home and community-based service programs provide insufficient benefits and often suffer from long waiting lists. They need more money. But with state budgets in deep trouble as a result of COVID-19, Medicaid funding is likely to go down, not up.
State and local governments provide these services today, but in a disconnected way. Like specialist physicians, each cares for a slice of a person, not a whole life. The agencies that deliver these programs need to work with one another to provide flexible, holistic care. Everyone else would pay for their long-term services and supports through a mix of private savings and self-funded, universal public insurance. It could be run through Medicare or as a separate government program.
Many could get their care at home—if they had a safe and accessible place to live and the necessary caregivers. For others, it would be more appropriate to live in a beefed-up assisted living facility or a group home.
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