Approximately 6.5 million, or 12%, of US older adults, are at risk of continuing to face limited options for their long-term care needs due to their income, according to new research from NORC at the University of Chicago. Part of the solution could be making assisted living more accessible through subsidies, the research brief suggests.
The new study builds on NORC’s 2019 research of the “Forgotten Middle” — those whose incomes are too low for them to be able to afford most senior living communities but too high for them to qualify for Medicaid assistance — and a subsequent update in 2022. Results were released Wednesday.
For the new research, the NORC researchers used 2021 data from the Medicare Current Beneficiary Survey. They found that “near duals,” people who aren’t quire eligible for both Medicare and Medicaid, are caught in a middle market gap — they have similar financial, health and functional needs and mobility limitations as those who are beneficiaries of both the Medicare program and the Medicaid program, but they are not eligible for the Medicaid long-term services and supports available to their dually eligible counterparts.
The study found that only a small portion of near duals (6%) transitioned to dually eligible status between 2017 and 2020, indicating that this population will continue to have limited options for long-term care absent “robust and timely” policy reforms. Those who did not transition to dually eligible status were sicker, less mobile and more likely to have experienced a fall that led to hospitalization compared with dually eligible individuals, according to the research.
Annual median 2020 costs were $51,600 for assisted living, $105,800 for a private nursing home room and $54,912 for a home health aide, according to the study, citing that year’s Genworth Cost of Care Survey.
“This research exposes a critical gap in our current system of funding long-term care,” Dianne Munevar, NORC vice president of health care strategy, said in a news release. “As a growing number of Americans reach older age, future policy should be informed by data around the needs of the most vulnerable older adults.”
Panel offers 4 solutions
NORC and The SCAN Foundation convened a panel of 20 leaders from the housing, healthcare and aging services areas to weigh in on the challenges facing the middle market, and offer corresponding policy recommendations. Among participants were Bob Kramer, co-founder of Nexus Insights; Lisa McCracken, head of research and analytics for the National Investment Center for Seniors Housing & Care; and Marc Cohen, PhD, co-director of the LeadingAge LTSS Center @UMass Boston.
The group came up with four policy recommendations “to facilitate a more affordable, equitable and accessible aging environment for middle-income older adults.”
- Develop a pathway for a new home- and community-based services benefit under Medicare that provides needs-based coverage for HCBS as a permanent new benefit or a demonstration program so that more near duals receive HCBS. Part of the menu of services could include subsidies for assisted living.
- Expand Medicaid eligibility requirements by incentivizing states to increase income eligibility limits so more near duals qualify for LTSS.
- Expand the scope and eligibility of home modification programs to help near duals remain in their homes longer.
- Increase flexible national funding for community-based services that directly support vulnerable older adults.
“Nearly 7 million older adults live in a perilous financial situation, which can be hazardous to not just finances, but healthcare and access, too,” SCAN Foundation Vice President of Policy Narda Ipakchi said in a statement. Policy change is “urgently needed,” he said.
NORC will host a webinar Oct. 25 at 1 p.m. ET to present its findings, followed by a discussion with experts from Justice in Aging, the Joint Center for Housing Studies of Harvard University and the California Department of Aging.
