Long-term care Medicaid Medicare What's Buzzing

Two in five older adults needing long term care do not get it

Written by Diane Archer

As they age, most older adults living in their communities rely primarily on family and other unpaid caregivers to help them cook and do laundry as well as to help them with bathing and dressing, according to a new report from the Commonwealth Fund. If their income is low, Medicaid may cover the cost of paid caregivers to provide these long-term care services and supports. But, two in five older adults needing long-term care do not get it. 

The federal government needs to fund long-term services and supports (LTSS) to ensure that all older adults and people with disabilities get needed care. Medicare does not cover LTSS. Today, significantly fewer than half of people with Medicare needing LTSS (43 percent) receive unpaid assistance from family, friends and community service programs. Because paid services are costly, only 15 percent of people with Medicare receive paid services; a lot of those people get those services through Medicaid

Two out of five people with Medicare needing LTSS today (42 percent) do not receive any LTSS, paid or unpaid. While people with Medicare and Medicaid are the most likely to receive paid LTSS, one in three people with both Medicare and Medicaid reported not getting any help. Whether they get help depends in significant part on their eligibility for LTSS in the state they live in, along with the waiting lists for services.  And, most of them rely heavily on unpaid support, regardless of whether they get paid support.

About 5o percent of people with Medicare who have three or more chronic conditions and substantial medical needs rely on unpaid care exclusively. And, one in five (20 percent) of these people receive no assistance with their personal care at all.

Because the population is aging, an increasing number of older Americans will need LTSS. The federal government covers about two-thirds of LTSS costs through Medicaid today, but more funding is needed for personal care services and to keep people out of nursing homes.

If the federal government covered LTSS, it would be in addition to the unpaid care people receive. It would not replace it. The Commonwealth Fund report found that people with Medicare receive the same amount of unpaid care whether they receive paid care or not.

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