Neoliberal Long-Term Care: From Community to Corporate Control

Area of Science:

• Public Health
• Health Policy
• Gerontology

Background:

• Long-term care (LTC) services, primarily funded by Medicaid, have transitioned from nursing home dominance to include home- and community-based services (HCBS).
• Nonprofit aging networks (ANs), including Area Agencies on Aging, traditionally administered HCBS programs.
• In the past decade, for-profit Health Maintenance Organizations (HMOs) managed by large insurance companies have increasingly replaced ANs in administering LTC services.

Purpose of the Study:

• To evaluate the rationale behind the privatization of publicly funded long-term care services.
• To examine the evidence supporting claims that for-profit managed care models offer greater savings, efficiency, and quality compared to traditional nonprofit models.
• To identify potential consequences of increased corporate control over public LTC services.

Main Methods:

• Analysis of policy trends and administrative shifts in publicly funded long-term care.
• Review of empirical evidence supporting the purported benefits of for-profit managed care in LTC.
• Discussion of potential future impacts of corporate involvement in public LTC administration.

Main Results:

• There is minimal empirical evidence to support the claims that for-profit privatization of LTC services leads to greater savings, efficiencies, or improved outcomes.
• The shift towards for-profit managed LTC programs appears driven by market ideology rather than demonstrated effectiveness.
• The trend indicates a growing corporate influence over essential public long-term care services.

Conclusions:

• The purported advantages of for-profit managed care in long-term care lack substantial empirical support.
• Policymakers' adoption of for-profit models is not strongly evidence-based.
• The increasing corporate control over public LTC services warrants careful consideration of potential future consequences.