The rising costs of long-term services and supports (LTSS), also known as long-term care, are one of the biggest—and least understood—risks facing older adults and their families. Nearly 70 percent of Americans will need LTSS, yet most lack meaningful protection against the financial and practical challenges that come with needing help over time. Middle-income families are especially vulnerable, often earning too much to qualify for Medicaid while being unable to afford high out-of-pocket expenses.
The Leonard Davis Institute (LDI) at the University of Pennsylvania, with support from The SCAN Foundation, examined why today’s long-term care financing system leaves so many older adults exposed and what federal policy solutions could help. The brief explores the drivers of the current crisis, including gaps in Medicare and Medicaid coverage, the limited reach of private long-term care insurance, and the growing reliance on unpaid caregivers who absorb the majority of care responsibilities.
Key elements of the report include:
- A clear snapshot of the financial risks families face today and how the system evolved to its current fragmented state.
- An analysis of policy pathways—including reforms to Medicaid and Medicare, as well as options for new public and private insurance models to create more stable and equitable protection.
- Considerations for federal leaders as they weigh long-term care financing reform, informed by evidence, economic realities, and the lived experience of older adults and caregivers.
The brief offers actionable recommendations for policymakers, researchers, and advocates seeking durable solutions to strengthen long-term care financing in the United States.
Access the brief here.
To hear more about the findings, Narda Ipakchi will speak on an LDI webinar on long-term care financing on December 12, 2025. Event details are available here.