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Journal of Health and Human Services Administration ; 44(3):195-218, 2021.
Article in English | ProQuest Central | ID: covidwho-1535196


The horrific death rate of nursing home residents due to COVID-19 has exposed the nation's longstanding failure to effectively manage public policies toward long-term services and supports (LTSS). Government agencies' dereliction in the enforcement of quality standards in nursing homes has been most visible. But equally important are provider payment policies that discriminate against people with low incomes, dependence on under-paid direct care workers or unpaid family caregivers, and-most broadly- underfinancing of LTSS that leaves people of all ages at risk of impoverishment and inadeqate care. These risks will only grow as the population ages. The Biden Administration and the Congress have an opportunity to capitalize on heightened public awareness with significant policy and management reforms. In the short term, that means not only the exercise of federal oversight authority to assure quality but also the enhancement of federal funding (through Medicaid) made contingent on adequate wages and support for direct care workers and auditable delivery of quality care-whether delivered in the nursing home or in the community. Over the longer term, enactment of a national program of social insurance is essential to address the LTSS risks and uncertainties facing people of all ages and assuring that, regardless of the state they live in, people receive the care they need.

J Aging Soc Policy ; 32(4-5): 350-357, 2020.
Article in English | MEDLINE | ID: covidwho-343189


The economic threat posed by responses to COVID 19 endangers financing for long-term care across the states that is already inadequate and inequitable. Increasing the federal share of Medicaid spending as unemployment rises would mitigate fiscal pressure on states and preserve public services. But unlike the demand for Medicaid's health care protections, which rises when economic activity declines, the demand for long-term care protections will grow even in a healthy economy as the population ages. Enhanced federal support is urgent not only to cope with the virus today but also to meet the long-term care needs of the nation's aging population in the years to come. Long-term care financing policy should be modified to either adjust federal matching funds by the age of each state's population, or fully federalize the funding of LTC expenses of Medicaid beneficiaries who are also eligible for Medicare.

Coronavirus Infections/epidemiology , Federal Government , Long-Term Care/economics , Medicaid/economics , Medicare/economics , Pneumonia, Viral/epidemiology , Aging , Betacoronavirus , COVID-19 , Health Expenditures , Humans , Pandemics , SARS-CoV-2 , United States/epidemiology