States are tackling the long-term care problem

With no federal action in site, some are launching public option programs

Here’s a tough reality to face: most of us will slow down as we get older.

You might be very active, independent, and engaged in your 60s, and beyond, but at some point that independence starts to shift to dependence—at least to some degree. And that reality raises a number of questions that can be difficult to answer years ahead of any possible need and determining how you will pay for it.

It’s critical to understand the type of care we’re talking about here. This is not a question of medical care provided by health care professionals in outpatient or hospital settings. Much of that will be covered by Medicare. Instead, we’re talking about what is commonly referred to as long-term care. These are services that help people who are frail or disabled with their daily living needs—bathing, dressing, using the toilet, preparing meals, shopping, walking, and taking medications. And Medicare won’t pay for it, with the exception of post-acute care in a skilled nursing facility following a hospital stay—and those payments are limited to 100 days of care.

Most people will require some assistance with daily living needs, but the intensity and duration are impossible to predict.

Four out of five 65-year-olds will need some amount of long-term care during their remaining years, according to the Center for Retirement Research at Boston College.The researchers found that one-fifth of retirees will need no support, but about one-quarter will have severe, and expensive, care needs.

Insurance seems like sensible way to protect against these unknown risks. But the private long-term care insurance business has floundered over the past decade.

The idea of a public-private solution is not new. A decade ago, Mr. Gleckman co-founded the Long-Term Care Financing Collaborative, which brought together policy experts with a wide array of political leanings. The group agreed on a framework that would combine a national universal government program with initiatives aimed at revitalizing the market for private policies.

In Washington, D.C., policymakers and lawmakers have long agreed on the need for a government-sponsored solution — but not how to pay for it,

Now, a handful of states are acting on their own. In July, Washington State will start the WA Cares Fund, a public long-term care insurance program. California is considering a similar plan. Minnesota and several other states are studying options.

Learn more in my latest Retiring column for The New York Times.