Carol Levine

In a recent commentary for New American Media, Carol Levine, director of the Families and Health Care Project at the United Hospital Fund in New York City, says current efforts to reform the U.S. health care system could overwhelm family caregivers if lawmakers fail to pair insurance reform with increased access to long-term care and an improved delivery system.

“[A]ccess to insurance alone will not solve problems of mismatched financial incentives, patient safety, fragmentation, inadequate primary and geriatric care and health disparities, such as between white and ethnic groups,” Levine states. “Without reforming the delivery system, insurance reform will be a half-way measure” (“Health Care ‘Reform’ Could Overwhelm Family Caregivers,” Aug. 13).

She also describes the proposed CLASS Act as “a limited solution at best.”

Speaking both from her professional experience and her life experience as a family caregiver, she expresses grave concern over the lack of support for such caregivers in the health reform debate. While she praises the national movement toward balancing nursing homes with more home and community-based services, she also points out that this system as currently constituted “is often a patchwork of programs administered by different authorities using different eligibility criteria and levels of service,” and that it depends largely on the “flawed assumption” that family members will be able to assume most of the care duties indefinitely.

PHI Director of Policy Research Dorie Seavey, who has explored the intersection (pdf) of paid care and family caregiving, agrees with Levine. She notes, “We cannot continue to think of family caregiving and paid caregiving as separate systems. These systems are highly dependent on one another, and family caregivers need a stable, well-trained paid workforce to help them manage the care of loved ones.”

Referring to the “Retooling for an Aging America” report’s prescription that “the definition of the health care workforce must be expanded to include everyone involved in a patient’s care,” Levine derides lawmakers for devaluing the status of long-term care by clinging to “outdated assumptions and standards,” in particular, the idea that it should be regarded as an informal domestic chore — “the traditional dismissive view of women’s work.”