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Proponents for Long-Term Care Fear that Bipartisan Infrastructure Proposals Will Leave Urgent LTC Improvements Unfunded

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Bipartisanship in Washington, D.C., is such a rarity these days that most people get excited when Republicans and Democrats can agree on anything. In recent weeks, a series of articles has made it seem like Congress and the Biden Administration are tantalizingly close to an agreement on a $1-plus trillion plan to improve the nation’s infrastructure. That may seem like a good thing, but national experts say there’s something conspicuously missing from current proposals: billions of dollars urgently needed to repair America’s crumbling infrastructure to support long-term care.

The Nation is “Once Again at a Crossroads”

We found this provocative opinion piece on the NextAvenue website, penned by Bob Blancato, who serves as national coordinator of the Elder Justice Coalition. Blancato, an advocate for wholesale improvements in long-term care facilities and options, pulls no punches when he expresses his fear that, in seeking a bipartisan bill, Congress is poised to punt on the issue of long-term care needs and ignore a desperate and deteriorating situation.

“We are once again at a crossroads,” Blancato writes, “in the long and sometimes tortuous history of addressing the issue of long-term care and long-term services and supports in America. The need is as great as it ever has been, perhaps greater, and we now have some excellent proposals and related legislation offering solutions.”  The chief trigger for his sense of urgency is the rapidly aging population. “We are in the middle of a significant demographic shift that will exacerbate the gaps in our long-term care supports and services,” he states.

Long-Term Care Missing from Bipartisan Plan

“In March,” says Blancato, “President Joe Biden proposed the American Jobs Plan which included a landmark $400 billion proposal for long-term care home and community-based services under Medicaid.”  He says Biden’s proposal would make permanent a program known as Money Follows the Person, designed to move people out of nursing homes and back into their homes or homes of loved ones. The President also proposes raises and better benefits for workers in the caregiving field, plus a plan to shorten the waiting list for home care and community-based services under Medicaid.

But those dollars seem to have ended up on the cutting room floor. “The $400 billion plan was scuttled when a bipartisan group of Senators came to an infrastructure legislative compromise focusing on traditional infrastructure (money for things like highways and bridges) and not human infrastructure like long-term care,” Blancato says.

Other Proposals for LTC Improvements are Under Discussion

While the bipartisan infrastructure plan currently getting all the attention seems to ignore long-term care needs, other proposals are very much alive, Blancato writes – even if their political future remains murky. Pennsylvania Democratic Senator Bob Casey has introduced a bill called the Better Care Better Jobs Act (with 40 co-sponsors) designed to help the home healthcare workforce.

In the House, New York Democrat Tom Suozzi has proposed what Blancato calls “one of the most transformative long-term care bills in years,” called the WISH Act (Well Being Insurance for Seniors to Be Home Act). “That bill would create a federal public-private partnership to provide long-term care insurance,” Blancato explains, “so older adults could receive the care and support necessary to remain in their homes and communities instead of having to ‘spend down’ their assets.”  Blancato writes that the WISH Act could “dramatically enhance long-term care options for older Americans” while slashing Medicaid costs by a quarter.

Prospects Uncertain for Long-Term Care Help from Washington

What are the odds of any of these proposals seeing the light of day and becoming law? “In some respects, the table is set,” says Blancato: “We are in the middle of a significant demographic shift that will exacerbate the gaps in our long-term care supports and services and we have viable proposals from the administration and Congress that could help address the crisis.” Nevertheless, because of what he calls “the headwinds of history” and the denial that the need is real, Blancato says he’s skeptical about prospects for passage.

“I have contended for years that America’s long-term care crisis is driven by denial,” he states. “Even though it is the largest unfunded liability confronting the boomer generation, there is no great public clamoring for action.” Still, a huge number of Americans say the issue needs to be addressed. According to Blancato, “LeadingAge, a group of nonprofit providers of aging services, just released a poll which found that 85% of Americans agree that now is the right time to think about building a better aging services system.”

Long-Term Care Should be a “Kitchen Table Issue”

Blancato writes that, because long-term care affects practically everyone, it needs to become what he calls “a kitchen table issue,” widely discussed and debated. “We have the opportunity — mostly through a budget reconciliation bill in Congress — to get some of these proposals passed,” he states. “The missing ingredients? Political action and political will.”

 But with so many voters agreeing that our elected officials have failed older adults for decades by ignoring and underfunding services for America’s aging population, maybe the wind is shifting. “Supporting government long-term care infrastructure funding always made good policy sense,” says Blancato.  “If you add great political sense to the mix, it just might change that picture.”

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(originally reported at

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