Covid-19 had taken the lives of 181,000 people in nursing homes, assisted living and other long-term care facilities ….. one-third of the national total. The troubles have intensified a spotlight on long-running questions about how communities can do a better job supporting people who need care but want to live outside an institutional setting.

I explore these questions in a new New York Times Retiring column posted this weekend. I interviewed a couple dozen experts for the story in areas ranging from health care to housing, urban planning and health care. I’m planning a series of podcast follow-ups to dive deeper into different aspects of the story.

My podcast guest this week is one of those experts. Anne Tumlinson is one of the nation’s top authorities in public policy on caregiving, having worked for years on Capitol Hill and in the private sector as an analyst, researcher and consultant. She is the founder of ATI Advisory, a Washington, D.C.-based research and advisory services firm that works to reform health and long-term care delivery and financing for the nation’s frail and vulnerable older adults.

But she also is the founder of, a fascinating national network of support circles for caregivers. Earlier in her career, Anne worked as a healthcare advisor to the late Congressman John Lewis (D-GA), and then as the lead for Medicaid program oversight at the Office of Management and Budget.

I asked Anne for her thoughts on the challenges people face when they need to make caregiving decisions for loved ones, most often on short timelines and without adequate preparation or knowledge — and, how that affects the choices that need to be made between institutional and home-based care.

Listen to the podcast here.