By Chris Adams

Robert Burke subtitles his talk on long-term care options “the dreaded nursing home discussion,” because for many families, it is just that: a highly complicated and emotionally charged conversation during a time of maximum stress.

Burke, a professor of health care administration at the Milken Institute School of Public Health at George Washington University, gave National Press Foundation fellows a sense of what those conversations mean for families, and for policymakers.

He started with a description of the different elements of long-term care, from post-acute care, to skilled nursing, to rehabilitation services, to assisted living options. The industry is changing rapidly, and the government – primarily through Medicaid but also Medicare – plays a big role in it.

That makes any discussion about long-term care also a discussion about government spending – particularly at the state level, where Medicaid plays a prominent role.

That spending has been skyrocketing. In 2000, total long-term care expenditures in the U.S. were $96 billion; in 2017, they’re expected to be $275 billion, Burke said. And on the family level, the expenses also loom large, with a bed in a skilled nursing facility running from $60,000 to $140,000 a year, depending on location and level of services.

Beyond the cost, there are major structural problems in the industry, including an ongoing shortage of skilled workers.

For many individuals, the primary question isn’t about the major policy trends but a more personal one: “Who will take care of me?” Burke asked.

Finally, he talked about some of the newer options in long-term care, including assisted living arrangements with larger units and increased amenities; specialized Alzheimer’s and dementia units; and long-term care insurance.

Most of all, he urged fellows to be aware of what is happening in the industry, since it will likely hit their parents in the not-too-distant future. “The tsunami is coming in the next decade,” he said.