LTC Bullet: How Much Worse Can Long-Term Care Get?

Friday, July 10, 2026

Seattle—

LTC Comment: If you think LTC is in trouble now, wait until the rest of the boomers hit age 65 in 2029! We explain after the ***news.***

*** Did you see all of these important LTC stories from the past few days? Probably not unless you track the industry media and academic publications full time. That’s what Steve Moses does so he can send these real time LTC Clippings to Center premium members daily.

7/8/2026, “As America Turns 250, It's Worth Celebrating Last Year's One Big Beautiful Bill,” by Brian Blase, Paragon Health Institute
Quote: “Maximizing freedom requires limiting government. Last year, Congress notched a win for freedom with the passage of the One Big Beautiful Bill (OBBB), or the Working Families Tax Cut Act. Although the cornerstone of the legislation was its provisions that lowered taxes, the legislation also expanded freedom by taking steps to reduce the tide of red ink emanating from federal health care programs, whose unsustainable growth poses one of the greatest threats to America’s long-term prosperity.”
LTC Comment: Have you seen the relentless media criticism of last year’s budget reconciliation law? Read this excellent summary of the OBBBA’s impact on government health care spending for a more accurate and objective analysis.

7/7/2026, “The Aging Population Is Changing States’ Revenue, Spending, and Service Demand Outlook,” PEW
Quote: “The United States’ population is aging rapidly. And as with other long-term shifts in social and economic conditions, the transition to an older population is already affecting state revenue and expenditures. Understanding and preparing for these ongoing changes will be critical to states’ future fiscal sustainability.”
LTC Comment: Read this report to learn now states are already in a world of fiscal hurt due to population aging. Then contemplate how much worse it will be without the ongoing federal Medicaid matching funds bonanza as new limits on the use of provider taxes, intergovernmental transfers, and state-directed payments take effect. No amount of planning will shield states from what’s coming. Expect less government help for LTC, not more.

If you’re not already a member of the Center for Long-Term Care Reform, join here. Check out our “Membership Levels and Benefits” for all the individual and corporate membership options. Join our campaign to ensure quality long-term care for all Americans. ***
 

LTC BULLET: HOW MUCH WORSE CAN LONG-TERM CARE GET?

LTC Comment: U.S. long-term care (LTC) is in a world of hurt. The symptoms are well known: access and quality problems, caregiver shortages, excessive reliance on unpaid family caregivers, exploding public costs, and so on. Bad as it is, however, evidence suggests it could, and likely will, get much worse.

Two articles in the current issue of Health Affairs support that discouraging conclusion. “National Health Expenditure Projections, 2025–34: Strong Utilization Growth Initially, Legislative Impacts Later” tells us that the key components of LTC spending will grow annually on average from 2025 to 2034 by the following percentages arriving at total spending across all payers in billions of dollars as follows:

Nursing care facilities and continuing care retirement communities: 4.4%, $338.3
Home health care: 8.1%, $367.8
Other health, residential, and personal care: 6.7%, $615.0

OK, that’s bad enough considering the 2024 numbers for the nursing homes, home health and other categories were only $219.9, $169.4 and $320.5, respectively. But consider how much worse LTC spending could get if the insights from the other Health Affairs article are not adequately reflected in these estimates.    

According to “Trends In Care Needs Among Older US Adults Diverged By Age, 2011–22,” a new cohort of markedly more unhealthy baby boomers is about to throw current expectations about LTC utilization and spending into a cocked hat.

For starters, consider the status quo: “Nearly half of older adults in the United States experience disability, often defined in later life as limitations with daily activities … .” (p. 790)  Half have ADL deficiencies? Already? That’s alarming enough. But consider what’s coming according to the “trends” article.

Among younger baby boomers, “swelling numbers” are living with ADL limitations, receiving paid care, and experiencing unmet care needs. Among older age groups, however, there were declines in care received in all settings without increases in unmet care needs. Overall, averaging the younger and older cohorts, trends for the 65 and older population appeared stable with half having ADL deficiencies.

But that current stability is misleading. This study only analyzed the front half of the baby boom generation. Future studies will address all the baby boomers and will not be balanced by the better health and LTC characteristics among the older cohort in the current study.

The trend article authors conclude “the sizable rise in the numbers of adults ages 65–74 with activity limitations (an additional five and a half million), receiving care (an additional three million), and with unmet care needs (an additional two million) over a relatively short period is sobering.” (p. 796)

“Sobering” is an understatement. America’s over 85 age population will triple by 2050 dramatically increasing the number needing LTC. The article therefore concludes:

Taken together, study findings point to continued swelling in the numbers of older adults with care needs as the second half of this generation reaches later life. They also suggest that the share of older adults with care needs, which has been flat for more than two decades, may soon begin to rise. (p. 796)

From its beginning in 1946, the baby boom generation dramatically transformed American society, culture and economy. It’s about to shake up LTC services and spending commensurately. The first tranche of baby boomers has more ADL limitations, requires more paid care, and has more unmet LTC needs than previous generations. Add in the younger boomers with LTC characteristics as bad or worse and we can expect the LTC service delivery and funding challenge to worsen radically.

So, what is to be done? Do either of the Health Affairs articles offer helpful suggestions? Alas, no. The projections article concludes “policy makers will undoubtedly continue to explore options for addressing the significant financing challenges for a sector that is expected to account for more than one-fifth of the economy by 2034.” (p. 732) Want to hang our hopes on policy makers finding a better funding source?

The trends article is no more helpful. “Study findings reinforce the need for robust policies, including innovations in workforce development and family supports, to address the growing care needs of older adults and their families.” (p. 797) Where will the money come from to reinforce robust policies? That’s typical doubletalk.

What these articles have in common with most others of their ilk is that they analyze symptoms and recommend solutions, but never ask why LTC is so dysfunctional in the first place. With no idea of the source of LTC’s many problems, such analysts have nowhere to go with their recommendations than to call for more government spending and regulation.

For an entirely different approach that addresses the cause of LTC problems first and then proposes solutions, read the Paragon Health Institute’s “Long-Term Care: The Problem” and “Long-Term Care: The Solution” and watch this “virtual LTC event” featuring age wave visionary Ken Dychtwald and leading LTC researchers. To find ample private funds for LTC, check out “Medicaid’s $100+ Billion Leak.” For what not to do, see “Medi-Cal-amity: California’s Reckless Expansion of Medicaid Long-Term Care to the Affluent.” See also “Better Long-Term Care for Billions Less.” Much more on long-term care here.