Op-Ed: James Balda: A smarter way to meet America’s senior care crisis

The concept of “right-sizing” care demands immediate attention. This possible solution centers on ensuring older adults receive the right amount of care in the setting that best matches their medical needs, level of independence, and social well-being. Too often, seniors today find themselves residing in the most expensive or most restrictive care option simply because alternatives are unavailable, unaffordable, or not covered by insurance. This is especially true for skilled nursing facilities, which provide a high level of care that may not be necessary but are often used for hospital discharge because they are covered by Medicaid and Medicare.

Addressing this imbalance requires policy solutions that expand access to community-based long-term care options, including assisted living communities that provide supportive services.

Proven Benefits for Veterans

The Federal Government has already acknowledged the value of right-sizing care for veterans by formally recognizing assisted living as an appropriate alternative to more expensive institutional care. The Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act established a three-year pilot program allowing eligible veterans to choose assisted living as a care option.

For veterans, right-sizing care has proven that lower costs and better outcomes can coexist. This is a critical insight that can be applied broadly, as public programs face mounting fiscal pressure.

Why the Same Model Should Extend to all Aging Americans

The challenges facing veterans are not unique. The broader senior population is confronting the same structural problems: a rapidly aging demographic, rising long-term care costs, and a system that too often funnels seniors into the most expensive or restrictive settings simply because the alternatives are unavailable or unaffordable.

A legislative proposal that would help more seniors find right-sized care, is The Caring for Seniors Act. This bipartisan legislation would help improve the affordability and accessibility of assisted living for older Americans. This bipartisan legislation, led by Reps. Brian Fitzpatrick (R-PA) and Lori Trahan (D-MA) would provide programs to increase access and affordability of assisted living and address the industry’s workforce development needs by:

Demographic and fiscal pressures are accelerating.  As outlined in the Caring for Seniors Act, caring for America’s aging population is projected to become the single most expensive domestic priority, placing unprecedented strain on both federal and state Medicaid budgets. In 2020 alone, the United States spent over $400 billion on long-term care. This is nearly 10% of all national health care spending. Without structural reform, these costs will continue to rise as the population ages, limiting seniors’ choices and increasing pressure on public programs.

Proof at the State Level

State-level programs are demonstrating that right-sizing care can work in practice. One example is Maryland’s Senior Assisted Living Subsidy (SALS) program, which provides financial assistance to eligible seniors who require help with activities of daily living but do not need the higher level of care provided in nursing facilities. The program enables qualifying individuals to receive services, including meals, personal care, and supervision, in an assisted living setting.

Programs like SALS illustrate how assisted living effectively bridges the gap between fully independent living and skilled nursing care. Residents maintain greater autonomy while receiving assistance with daily activities, medication management, and access to social engagement.

Combating Social Isolation

Right-sized care also addresses social isolation, a growing public health epidemic. Many seniors who would benefit from the social engagement and support of assisted living remain isolated at home, worsening the public health crisis for older Americans: Loneliness.

In 2023, the U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community found that the highest rates of social isolation are found among adult Americans over the age of 65. Moreover, loneliness is more than just a bad feeling; the Surgeon General’s report that the mortality impact of being socially disconnected is similar to smoking 15 cigarettes a day, even greater than that associated with obesity or physical inactivity. 

A national survey of more than 130,000 assisted living residents found that 14.3 percent reported feeling lonely, compared with nearly 30 percent of seniors living alone. Social connection improves health outcomes, and assisted living delivers it.

The Path Forward

Preparing for the Silver Tsunami requires structural reform, not crisis management. Right-sizing care prioritizes independence, affordability, and appropriate support, all while reducing costs and improving quality of life.

Right-sizing care is not a compromise; it is an upgrade. By expanding access to assisted living through policies like the Caring for Seniors Act, Congress can improve the quality of life for millions of older Americans, while easing the growing strain on Medicaid. The evidence is clear, the solution is bipartisan, and the moment to act is now.