Long-Term Care

With the first wave of 70 million baby boomers turning 65 this year, use of long-term services and supports (LTSS), which include home care, assisted living, and nursing home care, is on the rise. In this podcast, the authors and funders of a new scorecard measuring the performance of state LTSS systems, a resource that should help policymakers and providers identify gaps and develop solutions.

This document is the latest in a series of reports on Medicaid long-term services and supports (LTSS) spending. This year’s report contains newly available data and changes in the services that are included within LTSS. The report explains the changes, summarizes the data, and describes national trends.

A review of the federal financing mechanisms used by state agencies to implement the evidence-based employment models ( IPS and CE) come with the recognition that the federal financing of employment services for people with serious mental illness is a shared responsibility across multiple federal agencies. Improvements in this shared responsibility can lead to more effective support for these evidence-based employment models at the state and local levels.

The latest brief describes Medicaid expenditures in 2009, showing that 45% of its total long-term care dollars nationally were spent on home- and community-based services. The findings in this analysis are based on the CMS Form 64 data published by Thomson Reuters, detailing each state’s Medicaid expenditures.

The latest in a series provides background on the landscape of home- and community-based long-term care services funded by Medi-Cal, California's Medicaid program. In-Home Supportive Services (IHSS) is the largest personal care program in the nation.

Detailed data on community-based residential services providers indicated a high worker turnover for long-term care costs. The findings indicated that providers were unlikely to reduce turnover on their own, since its associated costs were either tolerably small or borne by others. An analysis indicated that it was socially beneficial for the government to reduce turnover through wage subsidization in this sector.

Person-centered outcomes underpin all aspects of desired assisted living practices and care. Service planning and operational process focused on person-centeredness is able to deliver core promises of assisted living that maximize privacy, autonomy, and choice; fostering meaningful life, engagement, quality of care, and meaningful access to the surrounding community.

This report provides data on Medicaid's role in financing long-term care, including serving as the primary payer for an estimated 63.6% of all nursing home residents. Congress recently offered an array of proposals that would significantly cut the Medicaid program. These proposals include converting the program into a block grant with straightforward cuts and global caps on spending. The latest proposal enables the states to significantly reduce Medicaid eligibility and enrollment.

This report explains the Jobs to Careers program, a model of training and education designed to advance the skills of direct-care workers. It describes how the program has been implemented in Hartford, Connecticut, and Portland, Oregon. The report also presents a list of next steps and recommended goals to improve state and federal policies relating to direct-care worker training. Jobs to Careers is managed by the national nonprofit Jobs for the Future.

This policy brief examines the program created to provide financial support for home care, adult day care or a nursing home stay, and highlights how policy-makers could make the program sustainable. Options range from changing the premium structure and lengthening the vesting period, to incentivizing employers and more. The Obama administration acknowledges the program’s shortcomings and will ensure the program remains solvent and self-financing for at least 75 years, as the law requires.