Maria Arozamena, Illustrations Editor

The elderly care crisis has hit new peaks in recent years as healthcare costs are making long-term home care difficult to access. Many families struggle to balance their work with caring for elderly family members and cannot access government-supported long-term home care.

Kamala Harris, the Democratic Party presidential candidate, promises to change that. 

This month, on the talk show “The View,” she announced the plan to expand the coverage of Medicare, the federal health insurance plan, to include long-term home nursing care for the elderly. The News talked to Yale healthcare experts, who expressed their support for the proposal but doubted that it will pass Congress. 

“I support policies that are going to help make my patient’s lives better, or make the communities in which they live stronger,” Dr. Joseph Ross, professor of medicine and health policy at the School of Medicine, told the News. “So by advancing home care through government support for the elderly, I think her [Harris] plan will provide a lot of good for everybody.”

Medicare provides health insurance for the elderly and is open to anyone who has paid payroll taxes for 10 years. While Medicare’s coverage has expanded to preventive health measures, and more people are now eligible for the program, there are still many coverage gaps. 

It still does not cover dental, vision or hearing care. And though it covers temporary skilled nursing care at a facility or at home, such as occupational and physical therapy, it does not cover long-term non-skilled nursing care, according to Dr. Howard Forman, who is a professor of radiology and biomedical imaging at the School of Medicine and a professor of health policy and management at the School of Public Health. 

The need for long-term home care

Long-term home aids help the elderly with daily activities, like “being able to feed oneself, to cook for oneself, to use the bathroom alone, to take your medications,” Forman said. “Doing the usual activities that you don’t need a doctor or a nurse to help you with, but you might need a human being to be able to help you.”

According to Ross, people need long-term home care for various reasons, from terminal illness to the normal phenomenon of older people needing more help as they age. And when the elderly cannot access long-term care, things can take a turn for the worse.

“They don’t bathe regularly, they don’t feed themselves well and they’re highly dependent on individuals coming and helping them out,” Ross said. “This leads to more of these patients who get admitted to the hospital having skin infections, pneumonia and cognitive decline that could have been prevented.”

According to Ross, Medicaid healthcare insurance, a federal program for low-income individuals, sometimes covers long-term nursing care at home. However, the Medicaid coverage of long-term care varies from state to state, for different states can decide Medicaid eligibility. 

When elderly people in the lower middle class do not qualify for Medicaid, hard decisions have to be made. Some families spend their wealth on care. Some even pay for home care services until they run out of money, essentially moving to the low-income category to qualify for the long-term care provided by Medicaid, Ross said, adding that “it’s a terrible problem.” 

Since many families cannot afford the cost, children, spouses and friends must act as unpaid caregivers for individuals who need long-term care. This creates a burden for families that have children to take care of and jobs of their own. 

“They are essentially ‘sandwiched’ between the needs of two generations, often facing significant financial, emotional and time constraints,” Dr. Alison Galvani, professor of epidemiology at the School of Public Health, wrote to the News. “They may provide financial support, help with daily tasks, offer emotional support, and coordinate medical care for both their children and their aging parents. But they often experience stress, burnout, financial strain, and difficulty balancing their own needs with the needs of their loved ones.” 

According to Forman, even when upper and middle-class families can afford long-term care, there is a shortage of home care workers for homes and nursing home facilities, leading to caregiver burnout and even lower accessibility to long-term care.

Harris’s proposal 

Under Harris’ plan, Medicare will cover long-term home care for beneficiaries. Additionally, Medicare will cover vision and hearing benefits to help seniors live longer independently.

“Kamala Harris is pointing out that this is a group that is not so easy to manage unless you provide some type of benefit,” Forman told the News. “It doesn’t have to be what a rich person would do, but it would be nice to be able to do something that allows an elderly individual to live their best life, even when they’re very elderly.”

Ross believes that these policies would make community lives better, allowing for extra support for the elderly and helping them to live a “more respectful, dignified life.” They would not have to move to the unfamiliar facilities of a nursing home and be separated from family. It would also lift the responsibility of their children.

Galvani said that the proposal would allow Medicare to live out its “true creed of universal healthcare.” She believes that comprehensive healthcare is a human right, and if healthcare doesn’t include long-term benefits to anyone, no matter their income, it isn’t comprehensive enough.

Harris hasn’t laid out the details of how she’ll execute her Medicare plans, but Ross believes that’s normal. 

“President Obama was a candidate when he talked about getting coverage for the entire United States by expanding Medicaid and doing things he didn’t have specific plans for as part of his run-up to the presidency,” Ross said. “It was only after he was elected, that he appointed folks to work out the details and figure out how to make it happen.”

Roadblocks to long-term care coverage

However, enacting the plan might be difficult. 

According to some estimates, such Medicare expansion would cost the federal government nearly $40 billion annually. Ross, however, believes that cost should not be a deterrent.

“[While] 40 billion sounds like a lot, the healthcare economy is in the trillions of dollars,” Ross said. “This sounds expensive, but it has so much greater potential upside. And I can see where the benefits are.”

Ross suggested that some of the funds spent on “new, expensive technologies like new MRI and CT scanners” that have “very, very marginal benefits” could be redirected toward funding long-term care.

Another roadblock is the need for bipartisan support for the plan to be enacted. 

According to Forman, Republicans haven’t been keen on supporting expansive government-provided health care. Not a single Republican, for example, has supported the Affordable Care Act, which was passed in 2010. 

Forman believes that to adopt the plan, Harris would need not only to win the presidential election but also a Democratic Senate and House of Representatives and have “some Republicans joining in.”

Ross suggested that if the plan were to be privatized and the services were provided by private organizations, Republicans would be more open to supporting it.

But even though the plan isn’t likely to pass Congress, Forman believes that Harris starting the conversation about long-term care is important.

“Running for office requires people to occasionally be audacious and put forth big ideas that improve the lives of people, and then you let the population decide,” Forman told the News.  “Most of our major pieces of legislation, whether it was Medicare or Obamacare, faced enormous obstacles, and people always start off by saying it’s going to be impossible. You only know what’s possible after you’ve made an effort.” 

According to Consumer Affairs, a consumer research journal, over half of Americans turning 65 today will develop a disability serious enough to require long-term service and support.