Impact of the COVID-19 Outbreak on Long-Term Care in the United States

Courtney Harold Van Houtven, Nathan A. Boucher, Walter D. Dawson

24 April 2020

This posts summarises key challenges in the long-term care policy responses to COVID-19 in the United States, which are explained in more detail in the latest country report for the United States on this site.

The United States (US) currently has the largest number of confirmed cases of COVID-19 of any country in the world – over 800,000 as of April 24 including more than 50,000 deaths. As in other countries, COVID-19 has significantly impacted the long-term care (LTC) system due to the medically fragile population served in these settings. Multiple long-standing systemic challenges within the US LTC system that disproportionality impact individuals of low-socioeconomic status, certain racial and ethnic populations, and certain geographies have been greatly exacerbated by this crisis. The response to COVID-19 is complicated by the federal political system, which ensures individual states and the federal government share overlapping –and at times conflicting— responsibility for responding to the COVID-19 outbreak.

Nowhere is this more pronounced than in LTC, where both the federal and state governments have overlapping regulatory and financing responsibilities, despite the US’s heavy reliance on the private sector and family caregivers to provide and pay for the bulk of all care and supports. The overlapping responsibilities of state and federal governments result in significant regional differences in the impact as well as in the response. This report identifies several challenges facing LTC due to the pandemic. These challenges include a lack of widespread testing, inadequate access to Personal Protection Equipment (PPE), financial support to providers, support of family caregivers and home care workers. Yet, much about COVID-19’s impact remains unknown. Near-term and long-term strategies for change of US LTC policy are needed to adapt and respond to COVID-19. True reform is predicated on mitigating ageism and ableism, which require a shift in society’s thinking. Yet policymakers can provide incentives to care for the most vulnerable populations, reducing barriers to Telehealth, and identifying and supporting family caregivers. Major reform of LTC policy financing is desperately needed to ensure a far more equitable LTC system in the US that is able to provide care and support for all those who need it.   

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