Providing affordable, high-quality long-term care to the elderly and disabled continues to present huge challenges to policymakers. Home health care has been a great option for many of our elderly who are home-bound. Some seniors are able to receive home care through Medicare, but it is often for a specific medical problem and only for limited amounts of time. Others can get home health aides if they meet the economic limits for Medicaid eligibility. Congress is discussing whether to include in the proposed health reform new programs to help people pay for home and community-based long-term care services. Health Affairs, a nonprofit health education organization that explores health policy issues, held a briefing this month discussing the role of long-term care in health care reform. One of the topics addressed was the “Community Living Assistive Services and Supports (CLASS) Act” which was incorporated into the House of Representatives’ Affordable Health Care for America Act”, and Senate’s “Patient Protection and Affordable Care Act”. In each program, Americans would be given an opportunity to have a new monthly premium deducted from their paychecks and make them eligible after five years for a daily cash benefit to purchase non medical long-term care services with a special focus on home and community-based care if they become disabled and require assistance with two or more activities of daily living. Unfortunately, this home care service would not be available to many people who really need some help, but are not incapacitated enough to qualify for home care. But, it is a start in addressing the care of the elderly and how we can give them quality care in the comfort of their own home as they age. At the local level in Virginia, Medicaid Waivers for home health care are slated to be cut at least 5%. Sadly, this will force many home health agencies that cater to Medicaid patients to close since their profit margins are so thin to begin with. Since keeping someone in a nursing home is two and a half to three times more expensive than home care, it would actually cost the state more if it enacts these cuts. Congress seems to understand better the cost savings involved with long term home care and home health aides verses the alternative of more expensive nursing homes. But, the national health reform bill has significant wasteful spending, which was instigated by special interest groups, and needs to be cut before some of the real health care reforms will ever be approved. In the meantime, only the poorest and wealthiest segments of the population are fortunate enough to benefit from long term home care and home health aides.