In addition to John Gravois’s important article on the Consumer Financial Protection Board, he penned another piece for the July/August issue of the Washington Monthly that draws attention to a fascinating idea that addresses a massive national problem: long-term care for the disabled elderly.

Let’s face it: nobody much likes nursing homes; continuous-care facilities require considerable assets; not every family has the time or space to take care of disabled parents or other relatives; and not every person needing care has family resources available in the first place. The better institutional settings for long-term care, moreover, cost someone–the patients, their families, or government–an awful lot of money.

But as Gravois notes, a tiny VA pilot program places disabled vets with no place else to go in foster homes. It’s a good deal for caregivers, patients, and the taxpayer alike:

Under the program, the VA pairs veterans who would otherwise live in nursing homes with ordinary citizens who are willing to take them into their homes and help them with tasks like bathing, administering medication, cooking meals, changing diapers, and the like. Veterans pay their caregivers an average of just under $2,500 a month, using their Social Security checks, VA pensions, and whatever other benefits and savings they have. And most crucially, the VA supplies primary medical care for the veterans right in their foster homes via what is essentially a suped-up system of old-fashioned house calls from nurses, doctors, and therapists—who thereby also provide regular oversight of the homes. This allows for dramatically lower cost, and better-coordinated care. (Treating a vet in a medical foster home costs the VA about $52 a day, compared with an average of $580 a day for those in nursing homes.) It also helps prevent the neglect and elder abuse that can be common in other small residential settings.

The good news is that a virtually unknown provision of the Affordable Care Act would create a pilot project called Independence At Home offering foster medical care to 10,000 Medicare beneficiaries.

If it succeeds, a vastly expanded system of foster care for the disabled elderly could follow


Such an approach could provide high-quality, cost-effective care for millions of Americans who would otherwise languish in nursing homes. It also could provide economic sustenance for able-bodied older homeowners who lack adequate retirement savings but have rooms to spare and, quite often, personal experience taking care of sick loved ones.

So we have another reason to be grateful that the Supreme Court upheld the constitutionality of the Affordable Care Act, and another small but promising initiative aimed at a problem that will become far more urgent in the years just ahead.

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Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.