Anne Tumlinson

Congressional leaders need to dedicate more Medicaid funding to home- and community-based services for people with long-term care needs to reduce their dependence on nursing home care and better help family caregivers, a prominent industry expert told a U.S. Senate committee Wednesday. 

“HCBS make it possible for many individuals with LTSS needs to remain where they want to be, which is in their homes,” said Anne Tumlinson, ATI Advisory founder and CEO. “But unfortunately our home care system and its infrastructure are vastly underdeveloped and under-resourced to meet the growing need for services.” 

“If we don’t invest in them, American families are going to face very serious economic challenges, possibly even more than they are today,” she added. 

Tumlinson’s testimony came during a hearing of the Senate’s Special Committee on Aging. It was forced to go virtual after Chairman Bob Casey (D-PA) was diagnosed with COVID-19. The ongoing pandemic influenced some senators’ concerns about the future of long-term care.

“I worry about the fact that too many people are forced into nursing homes or other congregate care facilities because they can’t access the care they need at home,” Sen. Elizabeth Warren (D-MA) said during the hearing. “The pandemic has made clear how devastating the consequences of those decisions can be.” 

On a call with LeadingAge members later Wednesday, Tumlinson emphasized that adequate funding for nursing homes remains essential, too, if families are to have a robust continuum of services to choose from.

But, she said, unlike nursing home care, federal Medicaid law does not require states to offer HCBS and “much more” federal investment is needed to galvanize and support states in developing the infrastructure to do so. 

“If we fail to make a sustained federal investment in HCBS, we will continue to rely heavily on unpaid family caregivers, and when they give out, nursing homes,” said Tumlinson, who is also the founder of a grassroots community of family caregivers, called Daughterhood. 

“Often, [family caregivers’] only choice aside from quitting [their jobs] is a nursing home because they can’t find adequate support in the community,” she added. “As the growth in the size of this very old population starts to accelerate, our families, employers, communities and states will feel these strains in a very pronounced way. Investing in HCBS is one of the most impactful actions that we can take today to support individuals in need and their families in the future.” 

Recent federal data has shown that Medicaid spending for HCBS has out-gained spending on institutional care, like nursing homes, for seven years in a row — a trend experts expect to continue for the near future.