Ohio’s Long-Term Care Crisis: What Other States Can Teach Us

Staff Writer

Ohio’s long-term care system is under strain. Aging demographics, rising costs, and a fragmented network of services are putting pressure on the state’s ability to care for vulnerable residents. While some improvements have been made, experts say Ohio lags states that have reimagined how to deliver and fund care.

The result, analysts say, is a system that too often forces families into crisis, spending down assets to qualify for Medicaid or settling for institutional care when home-based options would be less expensive and more humane.

The Scope of the Problem

Ohio’s 85-plus population is growing faster than any other age group, yet the state still relies heavily on Medicaid-funded nursing homes and a limited number of home- and community-based services (HCBS) slots.

“Ohio has a patchwork of programs and pilots, but no integrated strategy,” said one senior care advocate. “Your ZIP code often determines the quality and type of care you can get.”

Missed Opportunities

• No public long-term care (LTC) insurance program to provide a baseline safety net for middle-income residents.
• Limited reach of the Program of All-Inclusive Care for the Elderly (PACE), which other states use to reduce hospitalizations and extend independence.
• Workforce shortages in home care driven by low wages and high turnover.
• Inconsistent planning and transparency, with no statewide dashboard to track rebalancing goals.

Learning From Success

“Each of the six states was able to expand community-based care services without generating runaway costs in total long-term care spending.”

— U.S. Department of Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation (ASPE),
State Long-Term Care Reform

• Washington: WA Cares Fund provides a universal LTC benefit funded by a 0.58% payroll contribution, with an initial lifetime benefit of $36,500 indexed to inflation.
• California: Expanded PACE through day centers, telehealth, and mobile teams; research links PACE to fewer hospitalizations and better quality of life.
• Minnesota and New York: Used American Rescue Plan Act (ARPA) Section 9817 HCBS funds to raise wages, train caregivers, and modernize HCBS. New York implemented staged
  home care minimum wage increases.
• Oregon: Allows nursing task delegation in assisted living, supported by
  Oregon Health Authority (OHA) guidance, to lower costs while maintaining safety.
• Wisconsin and Maryland: Identified by HHS ASPE as states that expanded community care without runaway costs, using master plans and public-facing metrics.

Solutions for Ohio

• Establish a public LTC trust fund to protect middle-income families from financial ruin.
• Expand PACE to every major metro and rural service area.
• Launch a statewide workforce plan to raise wages, create career ladders, and improve retention.
• Implement managed long-term services and supports (MLTSS) with strong quality guardrails.
• Build a statewide LTC master plan with a public dashboard to track progress and ensure accountability.

A Question of Will

The question is not whether Ohio can fix its long-term care system — it is whether there is the political will to act before the demographic curve becomes a budget-breaking wave. Other states have shown you can control costs and improve care at the same time. Ohio just needs to move.