On the 23rd of April 2018, the CRC 1342 and SOCIUM were delighted to host a talk, “Long-Term Care in the US: Lessons to be learned,” by Ali Hamandi, a Trudeau Foundation Scholar and Ph.D. student at Harvard University. In addition to providing a comprehensive overview that helped to shed light on a highly fragmented and complex system of services, programmes, and financing schemes in place within and across the 50 US states, Mr. Hamandi’s talk addressed the growing interest in American policy discourse in “rebalancing” care for the elderly and/or disabled away from the institutional setting and more toward home care based services (HCBS).
In light of the constraints on autonomy and high costs associated with institutional care, greater investment in HCBS is generally preferred by care recipients and is also increasingly regarded as a civil rights issue amongst advocates for the elderly and disabled. Thus far, financing and provision for HCBS is mainly confined to the states’ Medicaid programmes, thereby restricting access to care for only those elderly and/or disabled that qualify under means testing. Hence the issue of unmet needs despite rebalancing efforts remains an ongoing challenge in the US.
In his talk, Mr. Hamandi raised a series of questions regarding the lack of evidence on the cost-effectiveness of care arrangements within the home, as well as the challenges for states with older and sicker populations for whom institutional care may not be avoided and even preferred. Mr. Hamandi also emphasized the potential role of so-called “tipping points” at which care needs may become so great that even the recipients of long-term care services may come to prefer full time institutional care over their own home.
In attempting to draw lessons to be learned from the US, Mr. Hamandi argued that while variation in how resources and benefits are redistributed across states raises equity concerns, decentralisation may allow for innovative practices and for local needs to be met.
Upon finishing his dissertation this summer, Mr. Hamandi will be taking on a health policy analyst position at the World Bank in Washington DC.
CRC 1342: Global Dynamics of Social Policy
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