The Poverty Crisis in Aging: When Access to Long-Term Care Requires Financial Hardship

As the population of older adults continues to grow, conversations about aging often focus on health, independence, and quality of life. However, another issue deserves equal attention: the financial reality of accessing long-term services and supports.

At the 2026 OPEN MINDS Aging Services & Supports Summit, Sarah Steenhausen, Deputy Director of Policy, Research & Equity for the California Department of Aging, described a troubling reality facing many older adults. To qualify for certain services they need to remain safe and supported, some individuals may essentially be required to “impoverish themselves” (Oss, 2026).

This raises an important question for behavioral health organizations, health care providers, families, and communities: Should an individual have to become financially destitute before receiving the long-term support necessary to live safely and independently?

The Gap Between Medicare and Long-Term Care

One of the challenges highlighted at the summit involves the distinction between Medicare coverage and long-term care needs.

Medicare can provide coverage for certain home health services when an individual meets specific eligibility requirements. However, these benefits are not designed to serve as comprehensive, indefinite long-term care for every person who experiences difficulty completing activities of daily living (Oss, 2026).

This distinction becomes particularly important as people age.

An older adult may not necessarily require hospitalization or continuous skilled nursing care, yet they may still need assistance with everyday activities such as bathing, dressing, preparing meals, managing medications, transportation, or safely navigating their home.

When those needs become ongoing, families may discover that the health care system does not always provide a simple path forward.

When Medicaid Becomes the Safety Net

Medicaid plays an important role in financing long-term services and supports for individuals who meet eligibility requirements. However, income and asset requirements can create difficult financial decisions for older adults and their families.

Oss (2026) highlighted the concern raised by Steenhausen that some aging consumers may find themselves needing to significantly reduce their financial resources before becoming eligible for the services they require.

The result is a difficult paradox: an individual may have worked and saved throughout adulthood, yet those resources may still be insufficient to privately finance years of long-term care. At the same time, having those resources may initially prevent the individual from qualifying for assistance.

This creates a vulnerable group of older adults who may be too financially secure to immediately qualify for certain public benefits but not financially secure enough to comfortably afford extensive long-term care.

Aging Is More Than a Medical Issue

These challenges also demonstrate why aging cannot be viewed exclusively through a medical lens.

Health is influenced by far more than a diagnosis. Housing stability, transportation, caregiver availability, income, food security, social connection, behavioral health, and access to community-based services can all influence whether an older adult can continue living independently.

An individual may be medically stable but still struggle to remain safely at home without assistance.

For behavioral health providers, this distinction is especially important. Older adults may experience mental health conditions, substance use disorders, cognitive changes, chronic illnesses, disabilities, or combinations of these concerns. When financial instability and limited access to supportive services are added to those challenges, maintaining continuity of care can become increasingly difficult.

The Importance of Home- and Community-Based Support

For many older adults, remaining in their homes and communities is an important part of maintaining independence and quality of life. Yet successful community living often requires a network of supports.

Those supports may include caregivers, transportation, medication assistance, behavioral health treatment, primary care, social services, meal programs, housing assistance, and other community resources.

The discussion highlighted by OPEN MINDS demonstrates why coordination across these systems is becoming increasingly important (Oss, 2026).

Instead of waiting until an individual experiences a medical, behavioral, housing, or financial crisis, communities must consider how services can work together earlier.

Looking Beyond Crisis-Based Care

The larger issue is not simply how society pays for long-term care. It is also when people become eligible to receive meaningful help.

A system that primarily responds after an individual has exhausted financial resources or experienced a significant decline may unintentionally encourage crisis rather than prevention.

As the population ages, health care and human service organizations will increasingly need to consider models that support individuals across the continuum of aging—not only after they reach a point of financial or medical crisis.

For organizations serving behavioral health, developmental disability, and substance use populations, this conversation is particularly relevant. The individuals receiving services today are also aging, and their needs may become increasingly complex over time.

Preparing for that future means considering the whole person: their health, behavioral health, financial circumstances, housing, caregivers, community connections, and ability to access the services necessary to remain safe and independent.

Growing older should not require becoming poor before help becomes available.

Creating a stronger system of aging services will require health care providers, policymakers, families, and community organizations to continue examining how long-term services are financed and how people can access support before their circumstances become a crisis.

Reference

Oss, M. E. (2026). The poverty crisis: The best of the 2026 OPEN MINDS Aging Services & Supports Summit. OPEN MINDS.