Care for Older Adults

Long-Term Care

Long-term Care Financing Collaborative

The Challenge

Foundational Principles


For the past three decades, policymakers have tried with little success to respond to the challenges of financing long-term services and supports (LTSS) to care for the millions of elderly and disabled Americans who need help. Long-term supports and services are non-medical assistance, such as food preparation, personal hygiene, assistive devices and transportation, as well as help with activities such as bathing and eating.  Today, 10-12 million adults require supports that help them maintain the best possible quality of life, a number that is expected to double by 2030.

As our nation’s 78 million baby boomers age, demographic trends show declining availability of family caregivers and increasing reliance on paid care, either at home or in residential facilities. The out-of-pocket costs of such assistance can be catastrophic, and few people have the necessary resources, through savings or private long-term care insurance, to meet this need. Providing this assistance puts an enormous burden on family members and friends, often results in poor care, and frequently causes preventable harm that endangers recipients of care and their caregivers, and increases medical costs.

Finding New Solutions
In 2012, a group of policy experts representing a wide range of interests and ideological views created The Long-Term Care Financing Collaborative to re-energize this discussion and build a foundation for new thinking and innovation. They asked Convergence to serve as the convener and facilitator. Through a series of structured meetings based on the Convergence dialogue-leading-to-action model, Convergence first helped Collaborative members better understand each other’s personal and professional interests and values as a foundation for their work.

In subsequent meetings, the group developed two interim sets of recommendations:

  • A list of foundational principles for designing a sustainable and affordable system of long-term services and supports.
  • Recommendations for the delivery of care that centered on enhancing the independence and choice of those receiving care and supporting the family members and communities that assist them.

The Collaborative also was instrumental in helping build a unique research partnership between The Urban Institute and the actuarial firm Milliman that led to a common understanding of the actuarial and economic impacts of several long-term care financing options. As a result of these efforts, the Collaborative laid the groundwork for establishing a comprehensive, holistic set of recommendations for providing effective and efficient long-term care delivery and financing.

Review the collaborative’s final recommendations.

Rethinking Care for Older Adults

Aging successfully, safely and happily requires a range of support services and types of accommodation. Unfortunately, too many older Americans spend many of their later years in institutions that are not best suited to their desires and social connections. To a significant extent, this is because regulations, payment systems and outdated models of care make a different array of options difficult to provide.

Building on our Long-Term Care Financing Collaborative dialogue in 2016, Convergence brought together almost 50 experts on care for older adults in three meetings during 2020 to brainstorm on the practice, policy, and business model changes needed to transform the system of care and the range of institutions.

See a summary of the conversations and their transformational ideas here.