Make Me Smart Can we fix America’s long-term care system?
Dec 18, 2025
Allison Hoffman, a scholar at the University of Pennsylvania specializing in health law and long-term care financing, joins the conversation to shed light on America's pressing long-term care challenges. She discusses the significant role immigrants play in the caregiving workforce and the implications of current immigration policies. Hoffman also highlights the financial burden on families providing unpaid care, the high costs of nursing homes, and the reasons behind stagnant wages for direct care workers. Solutions such as public programs and improved regulatory frameworks are explored.
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Medicare Doesn’t Cover Most Care
- Medicare does not cover most long-term personal care and Medicaid only helps after people impoverish themselves.
- Private long-term care insurance is rare, so most people lack affordable payment options.
Immigrants Are Essential Care Workers
- Immigrants make up about a third of the direct care workforce and a higher share in some states.
- Increased immigration enforcement and deportations threaten supply and access to in-home care.
Medicaid Rates Keep Wages Low
- Medicaid is the largest payer for paid long-term care and sets low reimbursement rates.
- States often use extra funds to expand hours rather than raise caregiver wages, so shortages persist instead of wages rising.