The long-term care system in our country isn’t on the verge of crisis—it’s already in one. Slowly, but undeniably, it is failing the very people it was meant to support.
I’ve spent nearly five decades working across financial services, health care, and public policy. I’ve served on presidential commissions, sat in closed-door briefings with lawmakers, and helped lead organizations working to meet the evolving needs of aging Americans. This crisis didn’t emerge overnight – we’ve seen it building for decades.
For more than 30 years, commissions under Presidents George H.W. Bush, Bill Clinton, George W. Bush, and Barack Obama all reached the same conclusion: our entitlement programs were never built to handle a rapidly aging population. There were moments when real reform seemed possible—when ideas were on the table and momentum was building. But again and again, the opportunities slipped by with inaction.
Now we’re living with the consequences. By 2036, the population aged 85+ will more than double. We’ll need nearly one million new assisted living units to meet demand, but we’re on pace to build only 40% of that.
Most Americans still don’t understand how long-term care works, what it costs, or how to prepare for it. And the reality is stark: home care now averages $77,792 per year, assisted living $70,800, and a private nursing home room more than $127,000—and those numbers are rising.
Nearly 70% of Americans turning 65 will need some form of care, but more than 95% of baby boomers lack private insurance to pay for it. Most will rely on unpaid family caregivers or Medicaid, which only steps in after someone has spent down nearly everything they have.
We are not prepared. Not families. Not the system. Not the economy. Not the country.
Let me be blunt: the chance to enact sweeping reforms in time to help the baby boomers has passed.
Structural reforms to Medicare or Medicaid are unlikely in today’s political climate, and new federal rules are making it even harder to qualify for the latter. Both programs face long-term sustainability challenges, but broad reform remains politically difficult—even as insolvency looms. That’s not defeatism. It’s realism.
So where does that leave us?
Focus on the possible
We must focus on what’s still possible. And that begins with rethinking how care is delivered, how we define quality, and how we help people afford it.
First, we need better planning tools. Today, most families make care decisions in a crisis—confused, overwhelmed, and without clear guidance. We must bring the same clarity to aging that we do to financial planning: nurse-led evaluations, accessible education, and unbiased support; not just product sales.
Second, we need to raise the bar on quality. Too often, care is chosen based on convenience or cost, not standards. Especially in home and community-based settings, we must define what good, person-centered care looks like and build networks around those expectations. This doesn’t require sweeping legislation—just transparency, data, and accountability.
Third, we must confront affordability. The system punishes the middle class: too poor to self-fund care, too rich to qualify for Medicaid. We need smarter contracting, vetted provider networks, and eventually, portable, flexible insurance products that fill the gap. Memory care, for instance, costs up to 30% more than traditional assisted living. Medicare fully covers just 20 days. Most people are left to cobble together care with out-of-pocket spending and fragile safety nets.
Fourth, we must shore up the workforce delivering care. Care workers are leaving the industry faster than we can replace them, driven by low pay, high demands, and little support. Families are filling the gap, providing approximately $600 billion in unpaid care each year while balancing jobs and other responsibilities. Nearly 60% of employees have already provided care to a loved one, and most expect to in the future. Strengthening this workforce—paid and unpaid—must be part of any serious path forward.
We should also support bipartisan proposals like the WISH Act, which would create a national backstop for catastrophic long-term care events and their associated costs. At the state level, Washington’s WA Cares program offers a modest but meaningful foundation. These models, paired with thoughtful private insurance solutions, point to a more realistic path forward.
Moving beyond identifying the problem
We know what the problem is and who it’s hurting.
What we need now is courage. Courage to act, to innovate, and to demand more from the system. Because the longer we wait, the more people fall through the cracks.
The current system cannot stretch to catch everyone. It was never built to. And looking away because the problem is complex, or politically inconvenient, is no longer acceptable.
The baby boomers are aging into the final chapter of their lives. We owe it to them, and to every generation that follows, to stop deferring action and start delivering solutions that meet the scale of the crisis.
