Today, we peer into long-term care in America — those services, both medical and non-medical, that patients in old age or with chronic illness need to perform activities of daily living.

More than half of older Americans will eventually require long-term care. And this number will only swell as we reach into the next decade when, for the first time in our nation’s history, there will be more elderly than children. Of these Americans, the vast majority would prefer to age at home and in their communities. But our long-term care system, such as it is, is ill-equipped to accommodate them. 

Nearly 1 million Americans nationally languish on waiting lists for home-based care, with an average wait time that exceeds 3 years. More than 50 million, meanwhile, serve as unpaid caregivers for their family. And 3 in 4 worry about not being able to afford a nursing home, which on average, costs $100,000 a year. By way of reference, the median household income among those 65 or older in 2018 was $44,000.

Medicare, the federal insurance program for older Americans, does not cover long-term care. Nor do most private insurance programs — which themselves exact exorbitant costs. Wealthy Americans can pay out of pocket, and Medicaid covers the very poor and disabled. But the vast majority — or “forgotten middle” — of Americans, have no sustainable option for accessing care.

Here to discuss this broken system — and why COVID-19 has exposed and exploited all those caught in its breach — is Dr. David Grabowski, Professor of Health Care Policy at Harvard Medical School and an acclaimed decades-long researcher of long-term and post-acute care. David has published dozens of articles on the economics of aging and is the perfect person with whom to explore both the challenges and the opportunities for long-term care in the United States. His reflections on this moment are not to be missed.

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