Can we fix America’s long-term care system?

Make Me Smart

Marketplace

News, Business

4.6 • 5.4K Ratings

🗓️ 18 December 2025

⏱️ 21 minutes

🔗️ Recording | iTunes | RSS

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Summary

Long-term care is expensive in the United States. With Medicaid spending cuts looming and the Trump administration’s deportation plans threatening the caregiving workforce, the system is under even more pressure. On today’s show, Allison Hoffman, health law expert at the University of Pennsylvania’s Carey Law School, joins Kimberly to unpack why the caregiving industry suffers from chronic labor shortages and how the U.S. could finance long-term care differently to make it more affordable.

Here’s everything we talked about today:

"What Role Do Immigrants Play in The Direct Long-Term Care Workforce?" from KFF
"Trump’s deportation plans threaten 400,000 direct care jobs: Older adults and people with disabilities could lose vital in-home support" from Economic Policy Institute
"A brief history of Medicaid and America’s long struggle to establish a health care safety net" from The Conversation
"The age-old problem of long-term care" from MIT News
"Solving the Home Care Quandary" from The New York Times

Join us tomorrow for “Economics on Tap.” The YouTube livestream starts at 3:30 p.m. Pacific time, 6:30 p.m. Eastern.

Transcript

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0:00.0	Hello, everyone, I'm Kimberly Adams.
0:08.0	Welcome back to Make Me Smart, where none of us is as smart as all of us.
0:12.2	This week, we're taking a look at the care economy in the United States.
0:16.2	Now, first of all, we talked about the enormous role that families play in caregiving and the financial strains that often come with it.
0:24.6	But the professional side of the care economy is also struggling.
0:29.4	The direct care workforce, like home health aides and nursing home staff, has had consistent labor shortages for years.
0:37.3	It's another piece of the long-term care system
0:39.8	that is just not working for so many Americans. So here to make us smart about this is Allison Hoffman,
0:47.2	Professor of Law and Health Sciences at the University of Pennsylvania's Carey Law School. Allison,
0:53.0	welcome to the show. Thank you. It's so nice to be here.
0:56.5	So give us an overview. What does the long-term care landscape look like in this country right now?
1:02.8	Give us a sense, especially on the professional side of things. Well, for a long time now, the long-term care
1:10.2	landscape has been defined by insufficient funding.
1:13.4	We don't have any kind of coherent way to pay for long-term care in this country.
1:17.3	We don't have a social insurance program like a lot of countries have or some kind of public
1:21.2	funding mechanism that pays for all people.
1:23.9	So we have this really patchwork way of paying for long-term care.
1:27.5	And unsurprisingly, what that has meant is that there's not enough money to pay for caregivers
1:32.2	or to grow the kinds of places where people might want to get long-term care.
1:36.7	And so we have shortages on that side as well.
1:38.4	We don't have the kinds of facilities that people would want to be in or we don't have enough
1:41.7	workers to provide care.
	...

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