Making the Best of Long-Term Services and Supports for Seniors

Katherine Pratt (Loyola Marymount University Los Angeles), Making the Best of Long-Term Services and Supports for Seniors, L.A. Legal Stud. (Research Paper No. 2021-32, 2021):

Living longer may be a blessing or a curse, depending on the quality of life seniors experience during their extended lives. Readers who heed the advice in The 100-Year Life, to plan ahead for multiple stages of a longer life, will have time and resources to re-create themselves in their later years. The 100-Year Life optimistically stresses the opportunities that longer life will provide—assuming that individual financial planning generates sufficient resources to fund a longer life. In fact, however, individual financial planning for retirement generally is inadequate, even before taking into account increased longevity. Fortunately, the federal government’s two largest social insurance programs—Social Security and Medicare—keep millions of seniors out of poverty. The Social Security old-age benefit partially replaces wages that are lost due to aging. Social Security uses a statutory retirement age as a proxy for being unable to work. The federal Medicare program provides hospitalization insurance (“Part A”) medical insurance (“Part B”), and prescription drug insurance (“Part D”) at subsidized rates to beneficiaries based on age, starting at age 65. 

The federal government does not provide universal social insurance for the risk of needing custodial care in old age. A majority of individuals age 65 or older will require Long-term Services and Supports (“LTSS,” also known as Long-term Care) at some point in their lives. LTSS include assistance with Activities of Daily Living (ADLs), such as eating, bathing, dressing, getting in and out of a chair or bed, walking, and toileting. This Chapter explores the implications—for current and future seniors and their caregivers—of increased longevity and other trends on informal unpaid LTSS and on publicly funded and privately funded paid LTSS. In addition to addressing alternative means of accessing and funding LTSS, this Chapter highlights recent innovations in LTSS, new developments in the law, and LTSS reform proposals under consideration. Projecting possible scenarios for LTSS in the future, this Chapter also notes opportunities for policy makers to improve the LTSS outlook for seniors and their caregivers, and ultimately to reduce the future need for LTSS by improving the healthspan—not just lifespan—of future seniors.