Congressman Demands Emergency National Conference on Aging to Confront Looming 'Caregiver Collapse'

In a dramatic call for urgent federal action, United States Representative Josh Harder (CA-09) has introduced legislation to immediately convene the 2025 White House Conference on Aging (WHCoA), warning that the nation faces a "caregiver collapse" unless comprehensive solutions are fast-tracked.

The quadrennial WHCoA, last held in 2015, is an essential forum for setting policy priorities for older Americans. Harder is pushing to make the mounting crisis in long-term care the sole focus, citing devastating financial and workforce shortages that are overwhelming families.

A caregiver collapse is coming, and we're running out of time to prevent it. Seniors can't get the care they need, and now many parents are being squeezed to provide for their parents and their kids at the same time. We need an all-hands-on-deck approach to change course before it's too late. — Representative Josh Harder (CA-09.)

Medicare Doesn't Cover Long-Term Care

Harder’s push seeks to raise public awareness about the catastrophic gap in coverage. Despite widespread public belief, Medicare and standard private health insurance do not cover long-term custodial care.

These health programs are exclusively designed for short-term, skilled care, such as hospital stays or limited rehabilitation. They offer minimal to no coverage for extended custodial care, including essential assistance with Activities of Daily Living (ADLs) such as bathing, dressing, personal hygiene, and eating, whether provided at home or in an assisted living facility.

This gap leaves millions of American families facing expensive in-home care, assisted living, and nursing home care, which, depending on where you live, can run over $125,000 a year, according to the LTC News survey of long-term care costs nationwide.

Many people who have not planned deplete their life savings before qualifying for the safety net program, Medicaid. However, those who have Long-Term Care Insurance have guaranteed tax-free benefits to pay for this extended care, even at home, but some experts say too many people ignore the problem until it is too late.

Harder's Plan to Address the Workforce Crisis: The SENIOR Act

To directly address the systemic issues that make care inaccessible, Rep. Harder’s legislative efforts have targeted the eight million worker shortage plaguing the long-term care industry.

While he has called for addressing workforce shortages, Harder has championed legislation such as the Safeguarding Elderly Needs through Innovation and Occupational Resources Act of 2024 (SENIOR Act) (H.R. 7605). This bill, had it become law, would have focused specifically on stabilizing the direct care workforce by:

• Workforce Expansion Grants: Establishing and expanding federal education and training grant programs through the Departments of Labor and Health and Human Services.
• Direct Care Training: Funding support for core certification and training requirements for the direct care workforce, including those in assisted living and home-based settings.

These measures aim to professionalize and stabilize the caregiving sector, which is currently characterized by low wages and high turnover, directly threatening the quality of long-term care provided to seniors.

Harder’s Top 3 Policy Pillars for the 2025 WHCoA

Rep. Harder is “demanding” that the Administration make these three specific priorities the core outcomes of the impending White House Conference:

Priority Focus Area Detailed Goal

1. Combat Workforce Shortages Caregiver Collapse Tackle the severe, projected shortage of direct care workers by developing initiatives to attract, train, and retain these professionals to stabilize the critical care infrastructure.

2. Expand Affordable In-Home Care Aging in Place Reduce financial and logistical barriers to quality, affordable Home and Community-Based Services (HCBS) to ensure older adults can receive care in their preferred setting.

3. Protect Existing Healthcare Safety Nets Affordability & Access Safeguard and strengthen health care access for seniors, specifically by protecting and supporting essential programs like Medicare, Medicaid (Medi-Cal), and the Affordable Care Act (ACA).

Existing Solutions: The Long-Term Care Insurance Options

While Harder calls for federal intervention, the primary private solution remains Long-Term Care Insurance. However, the market faces significant challenges: consumers perceive premiums as high, and industry consolidation has brought fewer solutions than in the past.

The LTC Insurance market offers two main approaches:

• 1. Stand-Alone LTC Insurance Policies: Traditional insurance policies designed solely to cover long-term care expenses. They require medical underwriting, but remain the primary solution. These plans include "Partnership" policies that offer additional asset protection.
• 2. Hybrid or Combination Products: Policies that combine life insurance or annuities with a qualified long-term care rider. If the care is never needed, the death benefit or annuity value is paid out, addressing the "use it or lose it" criticism of stand-alone policies.
• 3. Short-Term Cash Indemnity Policies: These plans offer reduced underwriting rules and expanded age brackets to older ages, allowing more people to obtain coverage. However, benefits can be less than those of traditional or hybrid products in some cases.

The Long-Term Care Insurance Partnership Program

A critical, but underutilized, tool to bridge the gap between private insurance and the public safety net is the Long-Term Care Insurance Partnership Program (LTCIP). Available in nearly all U.S. states, this program is a collaboration between state Medicaid programs and private LTC Insurance companies.

The key benefit is "dollar-for-dollar asset protection," which works as follows:

• Incentive: The program is designed to incentivize the purchase of private LTC Insurance.
• Asset Disregard: For every dollar the Partnership-qualified insurance policy pays out in benefits, the state Medicaid program must disregard an equal amount of the policyholder's assets when determining Medicaid eligibility.

• Example: If a person’s Partnership policy pays out $150,000 in benefits, that person may keep an extra $150,000 in assets above the standard Medicaid asset limit (typically $2,000) and still qualify for Medicaid to cover future LTC needs.

• Estate Recovery: The protected assets are also shielded from Medicaid Estate Recovery after the policyholder's death, allowing them to be passed to heirs.

To qualify as a Partnership policy, the insurance must be federally tax-qualified and meet state-mandated consumer protection standards, including an appropriate level of inflation protection.

Historical Significance of the White House Conference on Aging

Rep. Harder’s urgent call for the 2025 WHCoA is rooted in the body’s history as a catalyst for monumental social legislation. Held roughly once a decade, the WHCoA brings together advocates, policy experts, and federal officials to provide consensus policy recommendations to the President and Congress. Its purpose is to promote the dignity, health, and economic security of older Americans.

A Legacy of Landmark Legislation

The WHCoA has been central to the creation of the very foundation of the nation's aging policy:

• 1961 Conference: This landmark first conference is credited with laying the groundwork for the most significant expansion of the social safety net in U.S. history.
• 1965 Legislative Triumvirate: Recommendations from the 1961 conference directly informed and inspired the passage of three landmark pieces of legislation that year:

• Medicare (Title XVIII of the Social Security Act): Health insurance for the elderly.

• Medicaid (Title XIX of the Social Security Act): Health insurance for low-income and disabled individuals, which is also the primary federal funding source for long-term care for those who have exhausted their resources.

• The Older Americans Act (OAA): Established the national network of State and Area Agencies on Aging, which fund community-based services like Meals on Wheels, transportation, and caregiver support.

Shaping the Aging Agenda Since 1971

Subsequent conferences have continued to expand the nation's focus on aging issues:

• 1971 Conference: Led to the creation of the Senate Special Committee on Aging and paved the way for funding for a national nutrition program for the elderly.
• 1981 Conference: Was notable for formally ensuring representation for various population segments, including women, minorities, and people with disabilities.
• 1995 & 2005 Conferences: Focused largely on reaffirming and protecting the core programs of Social Security, Medicare, and Medicaid against proposed cuts, while also pivoting to the concept of "aging" as a lifelong process, recognizing the growing diversity and contributions of older adults.
• 2015 Conference: Focused on four key areas: retirement security, healthy aging, long-term services and supports (LTSS), and elder justice. This conference built momentum for policies that support aging in place and the use of technology to enhance seniors' lives.

By calling for the 2025 WHCoA to focus specifically on the long-term care crisis and the SENIOR Act's goals, Rep. Harder is seeking to position the current challenges as the next great policy issue, following in the footsteps of previous generations of advocates who achieved the passage of Medicare and the OAA.