An age-old problem: systemic inequality in health care for seniors and how Congress can fix it
By Alan Rosenbloom
Health care for aging Americans is a source of constant policy debate—but it’s a debate that must be settled soon.
The U.S. Department of Health and Human Services predicts that 70 percent of individuals who reach age 65 will require severe long-term care (LTC) needs—such as help with bathing, dressing, or eating. People with LTC needs rely on long-term services and supports (LTSS), but barriers to these important services exist for far too many Americans.
Millions of older Americans receiving home and community-based services (HCBS) do not have access to the same LTSS as their peers living in long-term care facilities, like nursing homes — leaving seniors living at home with unmet needs.
Our nation is unprepared for an increasing number of older Americans who will need LTC and who will likely want to live at home. As the past year demonstrated to a devastating level, LTSS services — particularly for those living at home — are finite and without experienced support, navigating care can be challenging for our most vulnerable citizens.
Long-Term Care Population
A new report analyzing Medicare beneficiaries shows older Americans with long-term care needs have more chronic and complex health care needs than those who do not need LTC. The Senior Care Pharmacy Coalition and ATI Advisory found significant similarities between Medicare beneficiaries with LTC needs regardless of their residence. It would make sense then, for both groups to have equal access to LTSS, but that is not the case.
In fact, 75 percent of Medicare beneficiaries with LTC needs live at home. This leaves most Medicare beneficiaries with LTC needs without equitable access to care simply because of where they live —exacerbating racial, gender, and socio-economic inequalities. For instance, Medicare beneficiaries with long-term care needs living at home are more likely to be Black or Hispanic/Latinx than their counterparts living in LTC facilities. Additionally, people with long-term care needs are significantly more likely to have mental and physical illnesses such as depression, diabetes, or a heart condition compared to those without long-term care needs.
Essential Care Must be Expanded
To better serve seniors living at home, we must expand access to essential care that those in LTC facilities already access. Policy changes must include equal access to LTC pharmacy services that are key to integrating LTSS and health care to improve quality of life.
As reported in the new analysis, on average, Medicare beneficiaries with long-term care needs living at home or in another community setting take 14 prescriptions per year, while those living in LTC facilities take only 12 prescriptions per year. Those living at home often rely on care from family and friends and would benefit from LTC pharmacy services that educate caregivers and better equip patients to understand their medications.
Without access to these LTC pharmacy services, people with LTC needs can more easily experience complications from polypharmacy, inadequate LTSS, or disruptions in care. LTC pharmacy services should be the hub around which effective coordination and integration aligns to support patient quality of life.
An Urgent Debate
Our policy debate cannot ignore the unmet LTC and health care needs of seniors who choose to age in the place they call home. Failure to ensure LTSS are expanded and well-funded will impact future generations. These inequities already impact many of us, and eventually will impact all of us.
One straightforward step for Congress to take is expanding Medicaid’s HCBS program to more people and guarantee the same services — including LTC pharmacy services — are also available to HCBS recipients. Legislation like the Better Care Better Jobs Act creates this opportunity.
Research and commonsense tell us that need should determine access to services — not race, ethnicity, sex, income, or location. People choose to live at home for many reasons and they deserve equitable access to long-term health care and services.
Alan Rosenbloom is the president and CEO of Senior Care Pharmacy Coalition, a national organization representing long-term care pharmacies.
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