Marketplace All-in-One Can we fix America’s long-term care system?
Dec 18, 2025
Allison Hoffman, a health law and long-term care policy expert from the University of Pennsylvania, joins to tackle the pressing issues in America’s long-term care system. She reveals how the U.S. funding patchwork burdens families and causes chronic labor shortages, heavily impacted by immigration policies. Hoffman highlights the high costs of care, with nursing home expenses often exceeding $100,000 annually. She advocates for a collective approach to care financing, suggesting social insurance as a solution to make it more accessible.
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No Coherent Long‑Term Care Financing
- The U.S. lacks a coherent, universal financing system for long-term care and relies on a patchwork of private pay and means-tested Medicaid.
- That funding gap leads to insufficient facilities and worker shortages, pushing care onto unpaid family members.
Medicare Doesn't Cover Personal Care
- Medicare does not cover most long-term personal care and Medicaid only helps people with very low income and assets.
- Private long-term care insurance is rare, so most people face huge out-of-pocket costs.
Immigrants Fill Care Jobs
- Immigrants make up about a third of the direct care workforce, with higher shares in some states and home care settings.
- Stricter immigration enforcement and deportations risk shrinking that workforce and reducing access to care.