I believe that, as a general rule, government should pay for long-term care for older adults who require it.
In the United States, we have a complicated and often deeply unfair system in which the government places strict conditions on paying for long-term care (LTC). If a person requires care in a nursing home or assisted living facility, they or their family are usually responsible for paying in full. The US government will often only pay for LTC when a person can prove that they have very little income or assets. This requires many people to sell or spend essentially everything they own, driving them into poverty before the government will extend coverage for LTC. I have seen this happen in my own family, and those of other people I have known.
People in this situation generally have little choice. Long-term can be often exorbitantly expensive, and there is no way to be sure when a person will need it, what level of care they will need, or for how long. While many Americans have some form of private health insurance, it often provides very limited coverage for LTC. Specialized LTC insurance exists, but many people are not aware that it exists or may be needed, cannot afford it, or otherwise have not acquired it. Older people and their families suffer both economically and emotionally from the uncertainty, anxiety, and financial burdens that result. For older people, it is a tremendous sorrow to see funds they hoped the next generations of their family could invest in their own educations and homes must instead be devoted entirely to their care, or contemplate leaving their children and grandchildren with tremendous debt owing to their care needs.
I understand that there are concerns about the potentially high costs of LTC coverage for public budgets. However, I believe that including LTC as part of universal health care is both more equitable and a solid long-term investment. As with traditional medical services, the government can use its position as payer to reduce costs. The government can also mitigate these costs over time by strengthening investments that can help prevent the need for costly institutional care. This could include expanding access to quality home- and community-based care, financial support for family caregivers, and other support services and public health initiatives that can help people to maintain their health and independent and to age in place.