Devolution and aging policy: racing to the bottom in long-term care

Area of Science:

• Public Health Policy
• Gerontology
• Social Work

Background:

• Federal policies like New Federalism and devolution have reshaped domestic health and human services.
• These shifts challenge the federal government's role in long-term care (LTC) delivery.
• The aging population and managed care trends add complexity to LTC policy.

Purpose of the Study:

• To examine the implications of devolution on long-term care in the U.S.
• To analyze how state-level policies affect LTC priorities, services, and benefits.
• To assess the potential for a 'race to the bottom' and various trade-offs in LTC.

Main Methods:

• Policy analysis of federal and state initiatives in long-term care.
• Examination of sociodemographic trends in aging populations.
• Review of the managed care movement's influence on service delivery.

Main Results:

• State discretionary policies may alter priorities and benefits for elderly and disabled populations.
• Concerns exist regarding a potential 'race to the bottom' in long-term care standards.
• Devolution may exacerbate generational, gender, racial, ethnic, and social class disparities.

Conclusions:

• The "devolution revolution" fundamentally alters the landscape of long-term care.
• State-level policy variations pose significant challenges to equitable and comprehensive LTC.
• The role and capacity of nonprofit organizations in the LTC continuum are likely to be impacted.