Research suggests that the United States could soon face a financial crisis in the long-term home health care industry, as U.S. residents struggle to cover home health care costs.
The increasing need for long-term care
HHS estimates that 69% of U.S. residents will need three years of long-term health services, on average, at some point in their lives. However, these services typically are not covered by private medical insurance, forcing patients to either pay for the services out-of-pocket, receive care from an unpaid family member, or purchase long-term care insurance.
According to a study published this month in Health Affairs, roughly 13% of adults pay for their long-term care out-of-pocket, which experts say will gradually become more difficult to sustain because of rising costs. Richard Johnson, a senior fellow at the Urban Institute's Income and Benefits Policy Center and a co-author of the study, said, "That means that many are going to have to rely on unpaid family caregivers, which creates burdens on those caregivers, go without care, or go into a nursing home."
Medicaid currently is the largest payer of long-term home health care services, covering about 43% of costs nationwide, but there are long waiting lists for the coverage. According to Kaiser Family Foundation data, there were more than 707,000 people in 40 states on waiting lists to receive Medicaid home health and community-based care benefits in 2017, which was an 8% increase from 2016.
Further, experts say the demand for long-term health plans could increase, as only one in 10 older adults who have been advised to purchase long-term care insurance plans have done so. Between 2002 and 2014, the number of long-term care insurance policies sold fell by 83%, according to the Urban Institute.
Current system is unsustainable, expert says
Johnson said the research suggests that the United States' current methods for financing long-term care are not sustainable and will lead to a crisis in the coming years. "We're already facing a crisis in terms of how to pay for long-term services and supports," he said, adding, "It's creating a real quandary for states."
US also faces a looming shortage of palliative care doctors, research finds
Research also suggests that the United States is facing a looming palliative care provider shortage.
For a separate study published this month in Health Affairs, researchers from Duke University analyzed 2018 workforce data and the results of a survey of more than 2,000 specialty hospice and palliative care clinicians from last fall. They discovered that about 33% of palliative care doctors reported feeling burned out, and about two in five of the doctors were at least 56 years old.
The researchers predicted there would be "a worsening of the patient-to-physician ratio for at least 25 years (2020–45)." The researchers added that the workload for palliative care doctors who remain in the field would lead to increased burnout among those clinicians.
Arif Kamal, a medical oncologist and palliative medicine specialist at Duke Cancer Center who led the study, said, "Our modeling revealed an impending 'workforce valley,' with declining physician numbers that will not recover to the current level until 2045, absent policy change."
The researchers recommended that Congress pass the Palliative Care and Hospice Education and Training Act, which House lawmakers introduced earlier this year. "Among its key provisions, the act would fund the development of physician leaders through palliative care academic career development awards, which are modeled on the federally funded Geriatrics Academic Career Award (GACA) Program," the researchers wrote (Ross Johnson, Modern Healthcare, 6/3; Japsen, Forbes, 6/3).
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