COVID‐19: The Time for Collaboration Between Long‐Term Services and Supports, Health Care Systems, and Public Health Is Now

Abstract

Policy Points To address systemic problems amplified by COVID‐19, we need to restructure US long‐term services and supports (LTSS) as they relate to both the health care systems and public health systems. We present both near‐term and long‐term policy solutions. Seven near‐term policy recommendations include requiring the uniform public reporting of COVID‐19 cases in all LTSS settings; identifying and supporting unpaid caregivers; bolstering protections for the direct care workforce; increasing coordination between public health departments and LTSS agencies and providers; enhancing collaboration and communication across health, LTSS, and public health systems; further reducing barriers to telehealth in LTSS; and providing incentives to care for vulnerable populations. Long‐term reform should focus on comprehensive workforce development, comprehensive LTSS financing reform, and the creation of an age‐friendly public health system. Context The heavy toll of COVID‐19 brings the failings of the long‐term services and supports (LTSS) system in the United States into sharp focus. Although these are not new problems, the pandemic has exacerbated and amplified their impact to a point that they are impossible to ignore. The primary blame for the high rates of COVID‐19 infections and deaths has been assigned to formal LTSS care settings, specifically nursing homes. Yet other systemic problems have been unearthed during this pandemic: the failure to coordinate the US public health system at the federal level and the effects of long‐term disinvestment and neglect of state‐ and local‐level public health programs. Together these failures have contributed to an inability to coordinate with the LTSS system and to act early to protect residents and staff in the LTSS care settings that are hotspots for infection, spread, and serious negative health outcomes. Methods We analyze several impacts of the COVID‐19 pandemic on the US LTSS system and policy arrangements. The economic toll on state budgets has been multifaceted, and the pandemic has had a direct impact on Medicaid, the primary funder of LTSS, which in turn has further exacerbated the states’ fiscal problems. Both the inequalities across race, ethnicity, and socioeconomic status as well as the increased burden on unpaid caregivers are clear. So too is the need to better integrate LTSS with the health, social care, and public health systems. Findings We propose seven near‐term actions that US policymakers could take: implementing a uniform public reporting of COVID‐19 cases in LTSS settings; identifying and supporting unpaid caregivers; bolstering support for the direct care workforce; increasing coordination between public health departments and LTSS agencies and providers; enhancing collaboration and communication across health, LTSS, and public health systems; further reducing the barriers to ...

Resilience amongst Ontario registered practical nurses in long‐term care homes during COVID‐19: A grounded theory study

“…Researchers from the United States suggest strategies for changing systems, policies and procedures such as requiring uniform public reporting of COVID‐19 cases in all LTC settings; identifying and supporting unpaid caregivers; bolstering protections for the direct care workforce; increasing coordination between public health departments and LTC agencies and providers; enhancing collaboration and communication across health, LTC and public health systems; further reducing barriers to telehealth in LTC; providing incentives to care for vulnerable populations (Dawson et al, 2021 ). The focus should be on workforce development, funding reform and the creation of a sustained age‐friendly health system, inclusive of a resilient healthcare workforce.…”

Care disruptions among the homebound during the COVID‐19 pandemic: An analysis of the role of dementia

“…Long‐term services and supports (e.g., paid caregiving, home‐delivered meals) in the home in particular may be vulnerable in times of crisis such as the COVID‐19 pandemic. 19 , 20 Such services are funded by a patchwork of payers; Medicaid is the primary government payer of long‐term care, but coverage varies significantly state by state and patients and families frequently pay privately for additional care to supplement the large amounts of care that families provide themselves. 21 , 22 , 23 The COVID‐19 pandemic has underscored how this direct care is necessary to support other care in the home and community and has brought attention to the need to further support both family and paid caregivers.…”

The Landscape of State Policies Supporting Family Caregivers as Aligned With the National Academy of Medicine Recommendations

“…For example, identifying caregivers and implementing caregiver assessments for visits with providers for Medicaid beneficiaries would be aligned with the National Academy of Medicine's recommendations to systematically identify caregivers and integrate them into the health care team. Relatedly, given that most adults in the United States over age 65 have Medicare, Medicare enrollment, “Welcome to Medicare” visits, annual visits, and plan purchasing (e.g., Parts C and D) present other opportunities by which states could systematically screen for and identify family caregivers to connect with supports 27 . Finally, the increased access to telehealth services established during the ongoing COVID‐19 public health emergency, 28 the rise of hospital‐at‐home programs, 29 and the continued development of more advanced assistive devices for care recipients 30,31 are additional opportunities to increase awareness of and provide support to family caregivers more broadly.…”