The Harris Campaign is Right to Pledge More Resources For Senior Home Care, But the Devil Will Be in the Detail

America has long been sleepwalking into a senior care crisis. As a nation, we’re getting older and living longer. And the more life expectancy improves, the more care we’ll need to live a dignified life during those later years. The problems, however, are manifold. Senior care is expensive, staff vacancies are high and public programs such as Medicaid are stretched too thin.

The Harris-Walz campaign’s recent pledge to invest in home care services for seniors is, therefore, a step in the right direction. However, details of how this will actually be achieved are somewhat lacking, considering the following is the sum total of the relevant part of this pledge, which also encompasses affordable childcare:

“As President, [Kamala Harris] will fight to lower care costs for American families, including by expanding high-quality home care services for seniors …”

But what this does facilitate is an open dialogue within the senior care industry in terms of the problems it’s facing along with some fresh thinking on how to solve these.

Placing this in context

Studies consistently show that a majority of Americans are either severely underestimating how much their senior care needs are likely to cost, or that they’re not saving enough to cover this. A KFF study published in November 2023 found that only 28% of those aged between 50 to 64 had put aside money to cover future care costs. The same report also found that 90% of adults would find it very difficult or impossible to cover the estimated $100k for nursing home costs, while 83% wouldn’t be able to cover $60k a year for assisted living costs.

For those who can’t pay, the only public safety net is Medicaid, which will provide coverage for certain costs in most states. However, the terms are punitive, specifically the requirement that you’ve spent all your assets down to the last $2k, meaning you’ll have nothing left to pass on.

It’s within this context that using home care to facilitate seniors to age in place (i.e. remain living independently in their own homes) offers a wealth of benefits. Firstly, it’s considerably cheaper than assisted living, secondly, a great deal of seniors prefer the option of living independently for as long as possible, and thirdly it reduces the overall demand on assisted living thereby helping to temper cost increases in that industry.  

Using public funds to fix dysfunctional private markets

The first thing any senior home care policy should address is funding, specifically, how we can better empower the individual to plan for their senior financial future. Defaulting to Medicaid is a suboptimal solution, as it drastically lowers individual choice while placing an enormous strain on public finances.

The main product in the market designed to provide cover for senior care costs, known as long term care (LTC) insurance, is barely fit for purpose. Two decades of inaccurate risk pricing and clumsy regulation has led to premiums being out of reach for many Americans. Recent studies show that only around 4% of adults aged over 50 have coverage.    

However, the concept of LTC insurance, where policyholders contribute a small monthly or annual premium to guarantee coverage of their senior care costs later in life, is a good one. We just need to fix the market to open up access to the majority of Americans. 

A government-backed public reinsurance scheme to absorb some of the risks faced by insurers and thereby lower premiums could help to achieve this and has been successful in other countries. Removing counter-productive exclusions on home care costs in some LTC policies is also a no-brainer that better regulation could tackle.

Removing labor market barriers

Staffing is the next biggest issue after financing. The only way the industry has been able to plug staffing gaps for decades now has been via immigration. Recent estimates state that one-third of care workers in the U.S. are immigrants. And staffing requirements will only increase further as our population continues to age. Put simply, to be able to deliver the level of home care services that seniors will need into the future will require us to import more labor from abroad.

This should trigger some creative thinking in terms of sensible reforms we could make to our immigration policies. There is currently no specific senior care worker visa, instead these applicants fall into the EB-3 (Other Worker) visa. 

It would be far more effective to create a special class of senior care worker visa, which would provide more flexibility and responsiveness in terms of the numbers of these visas we’d need to grant each year to match demand from the industry. It would also help to remove unnecessary barriers faced by applicants and red tape and costs faced by employers.   

Using technology in the right use cases

I’m forever wary of claims that technology alone will solve the problems of an industry that will always involve large amounts of person-to-person care. However, technology combined with smart policy and applied to the right use cases is always a net positive. For example, motion sensors installed into homes can collect data on daily movements, which is then analyzed by AI and can trigger alerts when an activity falls outside of a regular pattern. Likewise, bathroom usage sensors can detect irregular patterns that could indicate an infection or dehydration 

The acid test for this type of “age tech” is whether it can reduce costs while maintaining or even increasing the amount of person-to-person contact each senior receives. This type of technology can also provide significant improvements in situations where family members are primary caregivers, for example, giving family members peace of mind while they’re at work and out of the house.

Regardless of who wins in November, some difficult choices are going to be inevitable when it comes to fixing America’s senior care industry. But targeting policies at the areas most in need will deliver the biggest bang for our buck and will help ensure seniors can live with the dignity they deserve.

Photo: Flickr user forayinto35mm

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