Challenges in long-term care policy.

Abstract

Prologue: The increasing number of elderly people in the U.S. population poses a variety of public policy challenges. Not the least among them is the implementation of a strategy that provides long-term care in a cost-effective manner that is sensitive to the medical and social needs of older Americans. Answers to these questions will not come easily. Indeed, the Reagan administration and Congress chose to essentially ignore them as they moved to approve a new Medicare benefit that will provide elderly beneficiaries greater protection against the economic consequences of acute illness. The one essential reason for this failing? Long-term care benefits are too expensive and their projected future cost too difficult to predict. In this essay, sociologist David Mechanic outlines a strategy for long-term care that supports community participation and reinforces the informal care and support that already exist. It stresses that Medicaid should include protection against catastrophic illness but that this is only part of the solution. A strategy of long-term care is required that makes it possible for the elderly to obtain care without first becoming destitute. Overall, the challenge of long-term care is to develop a viable financing structure that is within a meaningful community context and consistent with efforts to sustain voluntary long-term care efforts. Mechanic is director of the Institute for Health, Health Care Policy, and Aging Research at Rutgers University, where he formerly served as dean of the Faculty of Arts and Sciences. An active member of the National Academy of Sciences' Institute of Medicine, Mechanic is the author of numerous books and articles, including three previous papers in Health Affairs.