ldi.upenn.edu (dec 2025) For more than 60 years, Congress has debated public policy around long-term care. Meanwhile, middle-class American families struggle to afford the care their older relatives need. Most people will need help with basic daily activities at some point in their lives, and many will be unable to pay for it. In this brief, we present an overview of the current long-term care crisis and its historical context . We present a range of options for reforming federal policy, from changing Medicaid and Medicare to creating a new public insurance program and addressing private market failures. We also illustrate the very real costs of the status quo, in the words of people facing the challenges of aging with dignity and providing care for their loved ones as they age.