The nonprofit Caring Across Generations and the National Academy of Social Insurance released a report today that makes a strong case for states to publicly support family care across the lifespan, from infants to elders. Through a social insurance model—think Social Security, Medicare or Unemployment Insurance—people would receive help to pay for child care, parental and family leave, and long-term services and supports (LTSS). “Everyone benefits from care supports—for children, for elders, for people with disabilities,” says Benjamin W. Veghte, research director of Caring Across Generations, who led the report team.
The 300+-page report outlines ways states can create and integrate family care programs, and offers examples of states that are leading the way. In May, Washington state passed the Long-Term Care Trust Act, the first in the nation to guarantee a public LTSS benefit, funded through a payroll tax. “We’ve had a poverty of imagination,” says Janet Kim, communications director of Caring Across Generations. “With Washington, we now have a model where we have a real acknowledgement that the magnitude of need is worth the investment in care.”
Washington’s new program will pay up to $100 a day, for up to 365 days, spread out over a lifetime for LTSS care in all settings. The state already has paid family and medical leave and is moving toward universal early childhood care.
“Government support is important,” explains Veghte, noting that only 7% of Americans over 50 have private long-term care insurance. “Voluntary insurance programs simply don’t work—no country has one. The only way to make it affordable is if everyone is required to help fund the program, from their first pay check to their last.” Veghte estimates the average worker would pay $79 a month to fund a Universal Family Care social insurance program. Depending on how the program is set up, people would have to wait a certain number of years before collecting benefits (known as prefunded) or could receive benefits sooner as needed (pay-as-you-go), with the fund replenished over time.
Consultant Anne Tumlinson, CEO of Anne Tumlinson Innovations and founder of a caregiver support site daughterhood.org, served on the LTSS panel for the report. “Politically, people have thought we’ll never get another social insurance program,” she says. “I used to work for the Office of Management and Budget. I’m not super liberal. I’m a Gen Xer and I’m not big on government spending. But mathematically, I can’t figure out another way to do it. The math doesn’t work if you don’t put everybody in the risk pool.”
The report offers states guidance on how to structure such a program and what considerations will arise, such as eligibility criteria, the generosity and length of benefits, and how the program will mesh with Medicaid and private insurance.
“Currently we have a patchwork of limited benefits,” Veghte says. For example, a family might have children in day care and a grandmother with dementia, who could manage at home with an aide. Most of the caregiving is paid for by families out of pocket or, in the case of nursing home care, by Medicaid for those who are in poverty or have spent down their savings.
Universal Family Care would benefit both families and state coffers, Veghte says, by extending the time older people could stay out of nursing homes. An actuarial study conducted in Washington estimated that by 2052, the state’s new long-term care benefit would save $470 million annually on Medicaid.
With Universal Family Care, “You’d have one access point for families to apply for the same program, for childcare and for homecare for a parent,” says Veghte. “Because it would be universal, there wouldn’t be all the paperwork to determine your income or if your assets were sufficiently low.”
Although the report focuses on state programs, advocating for Universal Family Care at the federal level is also important, he and other experts say. The climate is rapidly shifting, with ideas like Medicare for All, until recently unthinkable, now being seriously discussed. “But states shouldn’t sit on their hands,” says Veghte. “States already know how to provide affordable childcare through Head Start, and how to pay for long-term care through Medicaid. There’s no reason for them to wait.”
Universal Family Care would help those in the longevity sector as well, says Tumlinson. “Too many people getting involved in aging don’t see long-term-care financing as part of what they do,” she says. Entrepreneurs need to realize that having a financing stream in place to meet the needs of older people is “the fundamental enabler of success.”
She urges new businesses to join with the provider community in elevating LTSS financing on the public agenda, whether it’s writing op-eds, organizing at the state level, or contacting members of Congress. “Raise it in the context of the presidential campaign,” she adds. “If you’re at a town hall meeting, this is the question you should be asking. We’re going to be in a whole heap of trouble if we don’t even talk about it.”